Responded to acetaminophen

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Vignette 6 A 45-year-old womar presents to the ED with a spontaneous nosebleed. She reports 1 week of a fever that has not responded to acetaminophen. She denies cough, shortness of breath, abdominal pain, dysuria, and rash. Physical examination is notable for active bleeding from the nares bilaterally and numerous pinpoint red papules on her lower extremities. Lab evaluation reveals elevated white blood cell count, low hemoglobin/hematocrit, and low platelets. Pathogenesis. Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a clonal neoplasm arising from myeloid precursor cells. There are a plethora of subtypes distinguished by mc One distinctive Highlight Add Note Share Quote APL, which arises from promyelocytes. Clinical Presentation. AML is typically a malignancy of middle-aged adults. Presentation includes vague systemic symptoms including fatigue, fever, and weight loss, plus elevated white blood cell count with anemia and thrombocytopenia. Patients with APL often present with disseminated intravascular coagulation (DIC), which causes bleeding as seen in the vignette and paradoxical concomitant clotting. Diagnostic Studies.

- CBC demonstrates leukocytosis with predominately blasts (large WBCs with nucleomegaly and prominent nucleoli), anemia, and thrombocytopenia.

- Cytogenetics identifies classic translocations in many sub-types; t (15;17) PML-RARAis seen in APL. Morphologic Features.

- Peripheral blood smear:

Reference no: EM133866806

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