A 15-years-old boy presented with one day history of bleeding gum,subconjunctival bleed and purpuric rash. Investigations revealed followed results:Hb- 6.4 gm/di; TLC-26, 500/mm3 platelet 35,000 mm3; prothrombin time-20 sec with a control of 13 sec; paial thromboplastin time-50sec; and Fibrinogen 10mg/dL.Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely?
Answer is C (Promyelocytic Leukemia): Acute promyelocytic Leukemia (APL) characteristically presents with Thrombocytopenia, prolonged PT, Prolonged PTT, hypofibrinogenemia and increased levels offibrin degradation product as it is associated with a high incidence of DIC. The patient in question is presenting with an elevated PT, elevated PTT, Thrombocytopenia (platelets 35,000) and decreased fibrinogen levels (Normal fibrinogen levels = 233-496 mg/dl) All these features are characteristic of DIC which is a common mode of presentation in APL. APL is the single best answer of choice. Characteristic presentation of APL Patients are typically younger than other subtypes of AML Patients typically present with bleeding tendencies and/or DIC (as DIC is common in APL) Features of DIC Thrombocytopenia Prolonged prothrombin time (PT) Prolonged Paial Thromboplastin Time (PTT) Increased Fibrin Degradation products (N=0-1 ug/ml) Decreased Fibrinogen levels (N=233-496 mg/dl
Myeloblastic leukemia without maturation
Myeloblastic leukemia with maturation
Promyelocytic leukemia
Myelomonocytic leukemia