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APL with active disseminated intravascular coagulation (DIC): fibrinogen <150 mg/dL, prol...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-APL-EMERGENCY-DIC
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-APL
SourcesSRC-APL0406-LOCOCO-2013 SRC-ELN-APL-2019 SRC-NCCN-AML-2025

Red Flag Origin

DefinitionAPL with active disseminated intravascular coagulation (DIC): fibrinogen <150 mg/dL, prolonged PT/PTT, elevated D-dimer, thrombocytopenia + bleeding manifestations. Initiate ATRA AT CLINICAL SUSPICION before cytogenetic confirmation.
Clinical directionhold
Categoryorgan-dysfunction
Shifts algorithmALGO-APL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "fibrinogen_mg_dl",
      "threshold": 150
    },
    {
      "finding": "d_dimer_elevated",
      "value": true
    },
    {
      "finding": "active_bleeding",
      "value": true
    },
    {
      "finding": "dic_active",
      "value": true
    },
    {
      "comparator": "<",
      "finding": "platelet_count_k_ul",
      "threshold": 50
    }
  ],
  "type": "composite"
}

Notes

Triggers HOLD on regimen-choice algorithm pending DIC stabilization: aggressive transfusion (plt to >30-50K, fibrinogen >150, INR <1.5), ATRA initiation IMMEDIATELY (even before PML-RARα confirmation), ATO initiation as soon as confirmed. Per CHARTER §15.2 C2 this is partially time-critical (early-death prevention is the dominant APL outcome driver — historical 80% bleeding mortality without immediate ATRA). OpenOnco scope is workup + plan AFTER initial stabilization. Priority 5 (lowest = wins all conflicts). STUB — requires clinical co-lead signoff.

Used By

Algorithms

Indications