Residency Program - Case of the Month
December 2017 - Presented by Dr. Miao Tian (Mentored by Dr. Denis Dwyre)
A 33-year-old woman presented with heavy vaginal bleeding with large clots lasting for more than two weeks. Her signs and symptoms are also significant for abdominal pain and with the presence of a large 6 cm ecchymosis over the center of her abdomen without any known trauma.
Laboratory work-up showed normal aPTT and INR studies, an elevated D-dimer of 2574 ng/mL, and a complete blood count showing pancytopenia with severe neutropenic (leukocyte 0.8 x 109/L, Hgb 9 g/dl, platelet 49 x 109/L) and rare immature mononuclear cells (Figure 1). The bone marrow aspirate was hypercellular with numerous blasts and atypical immature myeloid cells seen (Figure 2). Marrow aspirate cytochemical staining with chloracetate esterase (CAE) showed numerous Auer rods with a prominent stellate shape (Figure 3).
Flow cytometry showed a population of abnormal immature myeloid cells with an immunophenotype: heterogeneous CD34+/CD11c-/HLA-DR -/CD117+ (Figure 4).
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|Figure 1||Figure 2|
What is most likely the diagnosis?
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E. Acute promyelocytic leukemia
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