Acute Promyelocytic Leukaemia

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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