Complications of Acute Myeloid Leukemia (AML)

Anemia

Anemia often complicates the course of cancer. While anemia may be a presenting sign of malignancy, it may also be a consequence of a patient's therapy or progressive disease. Anemia is a frequent cause of fatigue. Since fatigue ranks as the most common symptom plaguing cancer patients and limiting their daily routines, recognizing anemia, and its causes, is important for identifying appropriate interventions that may improve a patient's quality of life.1

Symptoms of anemia include2:

  • Fatigue
  • Weakness
  • Feeling cold
  • Feeling dizzy or lightheaded
  • Headaches
  • Pale skin
  • Shortness of breath

Infection

Patients with AML are at high risk for infections due to low white blood cell (WBC) count. Serious, life-threatening bacterial, yeast, and fungal infections remain a major cause of morbidity and mortality in these patients.3,4

Several risk factors, mainly severe neutropenia with a neutrophil count <0.1x109/L lasting more than 10 days, have been shown to increase the susceptibility to infections in AML patients. Although neutropenia poses the greatest risk of life-threatening complications, other risk factors are considered to predispose AML patients to infections, including3,5:

  • Impaired cellular and humoral immunity caused by the underlying disease
  • The degree of hemorrhagic diathesis of skin and mucosal tissue
  • Skin-penetrating venous catheters

Infections can be responsible for life-threatening illness in neutropenic patients.6

Bleeding7

People with AML bleed and bruise more easily due to thrombocytopenia. People with advanced AML are more vulnerable to excessive internal bleeding, which is the second most common cause of death in people with the condition.

Serious bleeding that may occur includes:

  • Intracranial hemorrhage: This causes symptoms such as severe headache, stiff neck, vomiting, and confusion
  • Pulmonary hemorrhage: This causes symptoms such as coughing up blood, breathing difficulties, and cyanosis
  • Gastrointestinal hemorrhage: This causes symptoms such as blood in vomit and tarlike feces

All of these types of hemorrhages are regarded as medical emergencies.

Transfusions

Leukemia patients are uniquely affected by both their disease and its treatment, resulting in a universal need for transfusions.8 Therefore, blood transfusions are an important part of supportive care for patients with AML4,9:

  • Red blood cell transfusions may help reduce the symptoms of anemia4
  • Platelet transfusions may help reduce the risk of serious bleeding4
  • Granulocyte transfusions can be used when an infection doesn't respond to antibiotics9

References: 1. Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst. 1999;91(19):1616-1634. 2. Signs and symptoms of acute myeloid leukemia (AML). American Cancer Society website. https://www.cancer.org/cancer/acute-myeloid-leukemia/detection-diagnosis-staging/signs-symptoms.html. Updated August 21, 2018. Accessed October 25, 2018. 3. Lech-Maranda E, Seweryn M, Giebel S, et al. Infectious complications in patients with acute myeloid leukemia treated according to the protocol with daunorubicin and cytarabine with or without addition of cladribine. A multicenter study by the Polish Adult Leukemia Group (PALG). Int J Infec Dis. 2010;14(2):e132-e140. 4. Cannas G, Thomas X. Supportive care in patients with acute leukaemia: historical perspectives. Blood Transfus. 2015;13(2):205-220. 5. Rowe JM. Managing patients with acute myeloid leukemia—importance of supportive care measures. Clin Adv Hematol Oncol. 2008;6(5)(suppl 12):1-2. 6. Sarkodee-Adoo CB, Merz WG, Karp JE. Management of infections in patients with acute leukemia. Oncology (Williston Park). 2000;14(5):659-666, 671-672, discussion 672-677. 7. National Health Service (NHS). Complications - acute myeloid leukaemia. https://www.nhs.uk/conditions/acute-myeloid-leukaemia/complications/. Accessed December 17, 2018. 8. DeZern AE, Williams K, Zahurak M, et al. Red blood cell transfusion triggers in acute leukemia: a randomized pilot study. Transfusion. 2016;56(7):1750-1757. 9. Leukemia & Lymphoma Society. Blood transfusion. https://www.lls.org/treatment/types-of-treatment/blood-transfusion. Accessed January 30, 2019.