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.

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