Extensive Splenic Infarction, Deep Vein Thrombosis and Pulmonary Emboli Complicating Induction Therapy with All-trans-retinoic Acid (ATRA) for Acute Promyelocytic Leukemia

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Abstract
Bleeding is a common complication during initial induction treatment for acute promyelocytic leukemia (APL). Administration of all-trans-retinoic acid (ATRA), which is in routine use for APL in the past decade improves the bleeding tendency dramatically. Nevertheless, thrombotic events have still been reported in a small proportion of APL patients treated with ATRA. Here we describe a case of splenic infarction and life threatening thrombosis in a young patient with APL treated with ATRA. We review the relevant literature and discuss the pathophysiology, risk factors and treatment of this complication occurring during therapy, for APL.