Booklet for Hemato-Oncologists
Case 18 (A) - Acute leukemia presenting with hyperleukocytosis and thrombosis
A 14-year-old Hispanic obese girl with a history of headaches, gingival bleeding, menorrhagia and bruising presented with a white blood cell (WBC) count of 83000/mm³ (90% blasts), Hb 62 g/l, platelet count 27,000/mm³, Fibrinogen 0.8 g/l, INR1.7, PTT 24 s, D-dimer > 400, urate 500 mol/l, LDH 764 µ/l, creatinine 60 mol/l, and albumin 38 g/l. Blood smear showed many abnormal cells with bilobar nuclei and cytoplasmic granules; some contained few Auer rods. (See attached figure). Flow cytometry showed expression of CD13, CD33, CD34, CD2, MPO, and HLA-DR by circulating blasts. Cytogenetic and molecular studies are pending.
A - What is the most likely subtype of this leukemia?
1. Acute Myelomonocytic Leukemia (M4)
2. Acute Monoblastic Leukemia (M5)
3. Hypergranular Acute Promyelocytic Leukemia (classic APL)
4. Microgranular Acute Promyelocytic Leukemia (M3v)
5. Acute Megakaryoblastic Leukemia (M7)
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