Acute Promyelocytic Leukaemia
This is of course Acute Promyelocytic Leukaemia – a diagnosis not to get wrong!
Not suspecting and treating this will have fatal consequences due to thrombosis and/or bleeding. If in doubt give ATRA!
Urgent tests that should be requested: coagulation screen (including fibrinogen), bone marrow examination including karyotype, FISH/PCR for APL-RARA, immunophenotyping, tumour lysis bloods (creatinine, electrolytes, phosphate, urate, calcium, LDH).
The classical morphological features are heavily granulated promyelocytes, cells with multiple Auer rods (Faggot cells) and bi-lobed nuclei.
A hypogranular variant can also be seen, usually associated with higher white cell counts.
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