Blood Res 2013; 48(4):
Published online December 31, 2013
https://doi.org/10.5045/br.2013.48.4.299
© The Korean Society of Hematology
1Department of Pathology, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India.
2Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
3Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
Correspondence to : Mukta Pujani. Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India. drmuktapujani@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 30-year-old woman (gravida 2, para 2, abortus 0) delivered a 2.1 kg baby girl through normal vaginal delivery but was otherwise healthy. She received 2 units of whole blood transfusion during labor and was discharged 3 days later. However, she was re-admitted 6 days following discharge with complaints of excessive bleeding per vaginum and bleeding gums. On examination, she was pale and afebrile with a pulse rate of 72 beats/min and blood pressure of 110/70 mmHg. There was no icterus, pedal edema, or lymphadenopathy, and no complaint of fever or bruising. Ultrasound revealed clots within the uterus possibly due to retained products of conception. There was hepatomegaly but no splenomegaly. Hematological investigations revealed the followings: hemoglobin level, 8.8 g/dL; total leukocyte count, 6.5×106/L; platelet count, 44×109/L; hematocrit, 24.4%; red blood cell count, 2.62×109/L; differential leukocyte count: blasts, 2%; promyelocytes, 65%; neutrophils, 4%; and lymphocytes, 29%. The abnormal promyelocytes were 2-4 times the size of small mature lymphocytes and had a moderate amount of cytoplasm with granules and Auer rods. The nuclei contained fine chromatin and 1-3 prominent nucleoli, and hallmark faggot cells were also observed (Fig. 1). The promyelocytes were strongly positive for myeloperoxidase. She was diagnosed with AML, suggestive of APL. Bone marrow aspiration was advised along with immunophenotyping and cytogenetic studies. The coagulation profile revealed the followings: prothrombin time, 15 sec (control, 13 sec); activated partial thromboplastin time, 31 sec (control, 30 sec); serum fibrinogen level, 110 mg/dL;
Acute leukemia during pregnancy is very rare with an estimated frequency of 1 in 75,000-100,000 [3, 6, 7]. AML accounts for approximately two-thirds of leukemia cases seen during pregnancy and the diagnosis is generally made during the second and third trimesters [3, 5]. PPH is occasionally due to an underlying coagulation or hematologic disorder, but PPH as a presentation of APL is extremely rare [8]. APL is commonly complicated by disseminated intravascular coagulation (DIC), seen in >90% of patients, and a life-threatening hemorrhage can occur in the brain, gut, or less frequently, the uterus. In such cases, it is very important to diagnose the underlying disorder as APL and it is curable with a good prognosis. The treatment of choice for APL is all-
Peripheral blood smear showing abnormal promyelocytes. Inset shows a faggot cell (Wright's stain, ×1,000).
Blood Res 2013; 48(4): 299-300
Published online December 31, 2013 https://doi.org/10.5045/br.2013.48.4.299
Copyright © The Korean Society of Hematology.
Sunita Sharma1, Mukta Pujani2*, and Narender Tejwani3
1Department of Pathology, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India.
2Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
3Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
Correspondence to: Mukta Pujani. Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India. drmuktapujani@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 30-year-old woman (gravida 2, para 2, abortus 0) delivered a 2.1 kg baby girl through normal vaginal delivery but was otherwise healthy. She received 2 units of whole blood transfusion during labor and was discharged 3 days later. However, she was re-admitted 6 days following discharge with complaints of excessive bleeding per vaginum and bleeding gums. On examination, she was pale and afebrile with a pulse rate of 72 beats/min and blood pressure of 110/70 mmHg. There was no icterus, pedal edema, or lymphadenopathy, and no complaint of fever or bruising. Ultrasound revealed clots within the uterus possibly due to retained products of conception. There was hepatomegaly but no splenomegaly. Hematological investigations revealed the followings: hemoglobin level, 8.8 g/dL; total leukocyte count, 6.5×106/L; platelet count, 44×109/L; hematocrit, 24.4%; red blood cell count, 2.62×109/L; differential leukocyte count: blasts, 2%; promyelocytes, 65%; neutrophils, 4%; and lymphocytes, 29%. The abnormal promyelocytes were 2-4 times the size of small mature lymphocytes and had a moderate amount of cytoplasm with granules and Auer rods. The nuclei contained fine chromatin and 1-3 prominent nucleoli, and hallmark faggot cells were also observed (Fig. 1). The promyelocytes were strongly positive for myeloperoxidase. She was diagnosed with AML, suggestive of APL. Bone marrow aspiration was advised along with immunophenotyping and cytogenetic studies. The coagulation profile revealed the followings: prothrombin time, 15 sec (control, 13 sec); activated partial thromboplastin time, 31 sec (control, 30 sec); serum fibrinogen level, 110 mg/dL;
Acute leukemia during pregnancy is very rare with an estimated frequency of 1 in 75,000-100,000 [3, 6, 7]. AML accounts for approximately two-thirds of leukemia cases seen during pregnancy and the diagnosis is generally made during the second and third trimesters [3, 5]. PPH is occasionally due to an underlying coagulation or hematologic disorder, but PPH as a presentation of APL is extremely rare [8]. APL is commonly complicated by disseminated intravascular coagulation (DIC), seen in >90% of patients, and a life-threatening hemorrhage can occur in the brain, gut, or less frequently, the uterus. In such cases, it is very important to diagnose the underlying disorder as APL and it is curable with a good prognosis. The treatment of choice for APL is all-
Peripheral blood smear showing abnormal promyelocytes. Inset shows a faggot cell (Wright's stain, ×1,000).
Peripheral blood smear showing abnormal promyelocytes. Inset shows a faggot cell (Wright's stain, ×1,000).