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APML-Associated DIC — RACP Adult Medicine MCQ

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HardHaematologyAPML-Associated DICRACP Adult Medicine

A 45-year-old man with acute promyelocytic leukaemia (APML) develops DIC with predominant thrombotic features. His coagulation profile shows low fibrinogen (0.9 g/L) and elevated D-dimer. He has digital ischaemia in two fingers. What is the most appropriate management?

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Correct answer: C — Platelet transfusion plus FFP plus cryoprecipitate plus treat underlying cause

APML-associated DIC has both bleeding and thrombotic components. Management is aggressive replacement therapy (platelets, FFP, cryoprecipitate) alongside initiation of ATRA (all-trans retinoic acid) and ATO (arsenic trioxide) which treat the underlying APML and resolve the coagulopathy. Fibrinogen should be maintained >1.5 g/L. The underlying leukaemia treatment is the definitive therapy.

Reference: BSH – 2024 – APML Guidelines; ISTH 2024