Patient case #5 - Acute Promyelocytic Leukemia
Description
9-year-old male with a rapid onset of pain, fever, cough, headache, shortness of breath and cold and flu like symptoms, including nausea and vomiting.
Patient presented in the Emergency Room and was evaluated for RSV and Flu; however, after about 3 hours in the ER the patient developed petechiae on his extremities and become more ill.
| Test | Result | Units |
|---|---|---|
| WBC | 2.1 | x10^3/uL |
| RBC | 2.61 | x10^6/uL |
| HGB | 7.3 | g/dL |
| HCT | 22 | % |
| MCV | 84.3 | fL |
| MCH | 28.0 | pg |
| MCHC | 33.2 | g/dL |
| RDW | 14.6 | % |
| PLT | 6 | x10^3/uL |
Diagnosis
Diagnosis: Acute Promyelocytic Leukemia, PML-RARA Positive Mutation
Flow: CD 34-, Cd33+, CD117+, CD13+, CD64+, HLA-DR-
Hyper-granular, FAB AML-M3
This is a classic case of a young male presenting with pancytopenia and immature and atypical promyelocytes. Many of them bi-lobed and butterfly shaped with Auer Rod inclusions. We see only one mature neutrophil and the patient is in DIC with extreme thrombocytopenia. The blast equivalents and blast cells are overwhelming.
Interestingly, as with the hyper-granular or usual type of APL the WBC is very low and you see that on the RBC grid run on the CellaVision DC-1 that there are no WBC’s, confirming a very low WBC. If you look at the feathered edge images on this smear you can see large clusters of immature cells present and this is an example of how large cells could go to the edge of the blood film. Of course, CellaVision found these immature/atypical promyelocytes in the monolayer. The images of the feathered edge are remarkable and stunning.
Patient appropriately treated with ATRA and ATO and recovering.