Clinical Case Database / Category: Patient Management
A case of easy bruising
Publication details
Dr Bethan Myers, Dr Anna Dillon
Foundation Years Journal, volume 9, issue 3, p.28 (123Doc Education, London, March 2015)
Abstract
We discuss the case of a 67 year old lady who presented with spontaneous bleeding and headache. Initial blood tests demonstrated a pancytopenia and deranged clotting tests. The blood film confirmed pancytopenia and demonstrated myeloid blasts with concerning features for acute promyleocytic leukaemia (APML). An urgent CT demonstrated acute intracranial haemorrhage. She was managed with aggressive blood product support and neurosurgical intervention. She was immediately commenced on all-trans-retinoic acid and subsequently chemotherapy to treat the leukaemia. The diagnosis was subsequently confirmed on bone marrow molecular studies. She is currently in remission from her leukaemia and has no neurological sequelae. We discuss an approach to the assessment of patients with spontaneous bruising and a summary of the pathophysiology and management of patients with APML.
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Authors
Dr Bethan Myers
Haematology Consultant, Departments of Haematology,
Lincoln County Hospital & University Hospitals of Leicester,
Lincoln County Hospital, Greetwell Road, Lincoln, LN2 5QY.
Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW.
bethan.myers@ulh.nhs.uk
Dr Anna Dillon (Corresponding author)
Specialist Registrar in Haematology, Department of Haematology,
QMC Campus, Nottingham University Hospitals, Nottingham, NG7 2UH.
anna.dillon@nhs.net
References
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2. Sanz et al. Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet Blood, 26 Feb 2009. Vol. 113.No.9.
3. Asou N, Adachi K, Tamura J, et al. Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic cid and chemotherapy. J Clin Oncol. 1998;16:78-85.
4. Sanz M, Martin G, Gonzalez M, et al. Risk adapted treatment of acute promyelocytic leukemia with all-trans-retinoic acid and anthracycline monochemotherapy: a multicenter study by thePETHEMA group. Blood. 2004;103:1237-1243.
5. Larson RA, Kondo K, Vardiman JW, Butler AE, Golomb HM, Rowley JD. Evidence for a 15;17 translocation in every patient with acute promyelocytic leukemia. Am J Med 1984;76:827-41.
6. Tallman M. et al. All-trans-retinoic acid in acute promyelocytic leukaemia. NEJM 1997. Vol 337. No.15
7. Breen. KA. et al Pathogenesis and management of the coagulopathy of acute promyelocytic leukaemia. British Journal of Haematology, (2011) 156, 24–36.
8. Barbui T, Finazzi G, Falanga A. The impact of alltrans-retinoic acid on the coagulopathy of acute promyelocytic leukemia. Blood. 1998;91:3093- 3102.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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