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)


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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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.

Dr Anna Dillon (Corresponding author)

Specialist Registrar in Haematology, Department of Haematology,
QMC Campus, Nottingham University Hospitals, Nottingham, NG7 2UH.


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About the Clinical Cases Database

T​he 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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