APL with cardiac comorbidity making ATO problematic: baseline QTc >500 ms, uncorrected hy...

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

ID	`RF-APL-ORGAN-DYSFUNCTION`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-APL`
Sources	`SRC-ELN-APL-2019` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	APL with cardiac comorbidity making ATO problematic: baseline QTc >500 ms, uncorrected hypokalemia (<3.5) or hypomagnesemia (<1.8), pre-existing arrhythmia OR severe hepatic dysfunction (bilirubin >3× ULN, transaminases >5× ULN)
Clinical direction	investigate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "qtc_ms",
      "threshold": 500
    },
    {
      "comparator": "<",
      "finding": "potassium_mmol_l",
      "threshold": 3.5
    },
    {
      "comparator": "<",
      "finding": "magnesium_mmol_l",
      "threshold": 1.8
    },
    {
      "finding": "uncontrolled_arrhythmia",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "total_bilirubin_ulnratio",
      "threshold": 3
    }
  ],
  "type": "composite"
}

Notes

Direction "investigate" — does NOT shift indication choice (because the alternative for ATO contraindication is classic AIDA, but that is itself surface-able through algorithm logic only after risk stratification). Triggers monitoring + electrolyte correction + ECG protocol + potential switch to AIDA / ATRA + chemotherapy alternative if ATO truly cannot proceed. Mandatory baseline ECG + K+ + Mg2+ + correction targets (K+ >4.0, Mg2+ >1.8) before ATO. STUB — requires clinical co-lead signoff.

APL with cardiac comorbidity making ATO problematic: baseline QTc >500 ms, uncorrected hy...

Red Flag Origin

Trigger Logic

Notes

Used By

Algorithms

Indications