My anemia and thrombocytopenia
A 62-year-old white male from the Bradenton-Sarasota area presented with anemia and thrombocytopenia.
A bone marrow aspiration and biopsy was done and a diagnosis of marrow failure due to myelodysplastic syndrome was made.
At another office, Procrit therapy was initiated and the patient was transfusion dependent for red cells and platelets. A second opinion was requested by the patient’s internist. The patient came to us stating…
“I FEEL TERRIBLE. I HAVE BEEN TOLD THAT I HAVE BONE MARROW FAILURE AND THAT I MAY NEED A BONE MARROW TRANSPLANT. WHAT DO YOU THINK?”
[tabs tab1=”Diagnosis” tab2=”Significant Findings” tab3=”Pharmacology” tab4=”Management” tab5=”Comments” tab6=”Patient Update”]
[tab num=1]Review of the patient’s peripheral blood smear in our office suggested that the patient’s correct diagnosis was acute promyelocytic leukemia and not myelodysplastic syndrome. A peripheral blood specimen sent for PCR confirmed the diagnosis with the presence of the PML/RARa-alpha gene (translocation of the retinoic acid alpha receptor gene).[/tab]
[tab num=2]Patient baseline platelet count 20,000, patient transfusion dependent for red cells. Disseminated intravascular coagulation (DIC) present with fibrinogen of 180.[/tab]
[tab num=3]The cornerstone of treatment for acute promyelocytic leukemia is completely different than that used for myelodysplastic syndrome and does not require bone marrow transplant.[/tab]
[tab num=4]This patient was treated with IV Arsenic trioxide and oral ATRA (all trans – retnoic acid). All the treatment for his acute leukemia was administered as an out patient and did not require a single day of hospitalization. After the first two weeks of treatment the patient did not require any further blood transfusions.[/tab]
[tab num=5]The correct diagnosis and treatment of APL resulted in a probable cure of the patient’s underlying bone marrow problem. Bone marrow transplant was obviously not required.[/tab]
[tab num=6]The patient has been off treatment for two years and remains in complete molecular remission.[/tab]