SHM Converge Scientific Abstract ePoster Gallery-Acute DVT as an Initial Presentation of Acute Promyelocytic Leukemia

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This case describes a 31-year-old woman who presented with worsening bilateral leg pain and was found to have an acute deep vein thrombosis (DVT) in the left gastrocnemius vein, along with superficial thromboses in the right ankle and right arm. Initial evaluation also revealed pancytopenia, including low white blood cells, hemoglobin, and platelets. Because of the combination of thrombosis and pancytopenia, the differential diagnosis included conditions such as paroxysmal nocturnal hemoglobinuria, autoimmune disease, and acute promyelocytic leukemia (APL).<br /><br />Further testing showed blasts on peripheral smear and flow cytometry, raising concern for APL. The patient was started promptly on all-trans-retinoic acid (ATRA) and prednisone while waiting for confirmatory studies. Bone marrow biopsy later demonstrated 44% blasts, and fluorescence in situ hybridization (FISH) confirmed the t(15;17) translocation, establishing the diagnosis of APL.<br /><br />The discussion explains that APL is a subtype of acute myeloid leukemia associated with the t(15;17) translocation involving the RAR-alpha gene. APL commonly causes bleeding due to disseminated intravascular coagulation (DIC), but thrombotic complications can also occur. Although thrombosis is more often seen during treatment, it can rarely be the first sign of disease. The case highlights that APL can present with serious thrombotic events such as DVT, myocardial infarction, or stroke.<br /><br />Overall, this report emphasizes the importance of considering an underlying hematologic malignancy in patients who present with acute thrombosis and pancytopenia, since early recognition and treatment of APL are critical to improving outcomes.

Asset Subtitle

Mishouri Paul

Meta Tag

Author List Koushik Paul, Mishouri Paul, Prodip Paul, Shreya Sinha

Category Clinical Vignettes

Concept Acute Promyelocytic Leukemia

Concept All-Trans Retinoic Acid

Concept Pancytopenia

Concept t1517

Concept Disseminated Intravascular Coagulation

Distinguished Non-Finalist

Presenter Organization Geisinger Community Medical Center, Scranton, PA

Presenting Author Mishouri Paul

Track Adult

Keywords

acute promyelocytic leukemia

APL

deep vein thrombosis

pancytopenia

thrombosis

t(15;17) translocation

all-trans-retinoic acid

bone marrow biopsy

disseminated intravascular coagulation

hematologic malignancy

Acute Promyelocytic Leukemia

All-Trans Retinoic Acid

Pancytopenia

t1517

Disseminated Intravascular Coagulation