Abstract Number: PB2096
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: L-Asparaginase (L-ASP) is a chemotherapeutic agent used to induce disease remission in children with acute lymphoblastic leukemia (ALL). Common side effects such as allergy and pancreatitis, as well as coagulation and lipid disturbances may ocur within L-ASP treatment . Hypertriglyceridemia and low antithrombin 3 levels are the most important laboratory abnormalities. Low antithrombin 3 activity is the most important cause of thrombosis.
Aims: L-ASP is a critical component of ALL treatment but is associated with multiple potential toxicities, including hypertriglyceridemia.We present a case with hypertriglyceridemia presenting as pseudohyponatremia and cerebral venous thrombosis.
Methods: –
Results: We present a 15 year old male patient diagnosed with ALL followed up with treatment of ALLIC-BFM 2009 moderate chemotherapy risk group. Eighth dose of L-ASP therapy was applied on the 33rd day of chemotherapy regimen. Then, three days later (on 36rd day) patients admitted with complaints of abdominal pain, nausea and severe headache. Stupor was detected on physical examination. Initial laboratory findings were as follows; Serum sodium: 125 mmol/L, Aspartate aminotransferase: 88 U/L, Alanine aminotransferase:123 U/L, Total bilirubine:0,3 mg/dL, Triglyceride:1506 mg/dL, Total cholesterol :349 mg/dL, HDL: 92,3 mg/dL, LDL:154,7 mg/dL, Antithrombin 3 activity 35,6%, Fibrinogen:101,1 mg/dL, Amylase:60/L, Lipase:18 U/L. Confluens sinus, left transverse sinus trombosis and a filling defect compatible with cerebral venous thrombosis was observed on brain magnetic resonance imaging scans. Low molecular weight heparin, gemfibrozil, diet and supportive treatment were initiated in the patient. Clinical improvement was seen after 2 weeks. Improvement in the laboratory parameters were found at the end of the first month. In addition, recanalized venous sinuses were seen on the control MRI examinations.
Conclusions: In this case, we wanted to emphasize that hypertriglyceridemia as a complication of L-ASP therapy may be caused by pseudohyponatremia and cerebral venous thrombosis. Early diagnosis and initiation of proper dietary and medical treatment is thus essential.
To cite this abstract in AMA style:
Uzel H, Soker M, Öncel K, Yilmaz K, Söker S. L-Asparaginase Induced Hyperlipidemia, Pseudohyponatremia and Cerebral Venous Thrombosis during Acute Lymphoblastic Leukemia Remission Induction Therapy [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/l-asparaginase-induced-hyperlipidemia-pseudohyponatremia-and-cerebral-venous-thrombosis-during-acute-lymphoblastic-leukemia-remission-induction-therapy/. Accessed March 22, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/l-asparaginase-induced-hyperlipidemia-pseudohyponatremia-and-cerebral-venous-thrombosis-during-acute-lymphoblastic-leukemia-remission-induction-therapy/