A 69-year-old with neutropenia and anemia: NEJM case report
A 69-year-old man was referred for the evaluation and treatment of neutropenia and anemia. The complete blood count showed a white-cell count of 1000 per microliter (reference range, 4800 to 10,800 per microliter), with 10% neutrophils (absolute neutrophil count, 100) and a hemoglobin level of 10.6 g per deciliter (reference range, 14 to 18 g per deciliter).

Bone marrow aspiration revealed 5% blasts and 65% promyelocytes; many promyelocytes had prominent Auer rods (arrows) and mitotic figures. The patient was started on all-trans retinoic acid. Fluorescence in situ hybridization showed a translocation involving chromosomes 15 and 17, leading to the production of a fusion protein, promyelocytic leukemia–retinoic acid receptor alpha, which confirmed a diagnosis of acute promyelocytic leukemia (APL).

Auer rods can be seen in most subtypes of acute myeloid leukemia, but when such rods are abundant, they suggest APL. This form of leukemia is associated with the development of disseminated intravascular coagulation, a risk that can be mitigated by the early initiation of treatment with all-trans retinoic acid.

The patient completed induction and consolidation therapies with all-trans retinoic acid and arsenic trioxide and was in complete molecular remission at follow-up 10 months later.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1612344
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