VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

11 Acute Promyelocytic Leukemia

Peng Yin, DO; Sidrah Ghaffar, DO Corresponding author: Peng.yin@lpnt.net

SOVAH Health Internal Medicine Residency Program

daily, Losartan/Hydrochlorothiazide 100-25 mg 1 tab P.O. daily, Montelukast Sodium 10 MG PO daily, Oxybutynin Chloride 10 MG PO daily. Social history: Lives in a group home alone. Able to perform all ADLs independently. No oxygen at baseline. In a relationship with a male partner. Denies any tobacco, alcohol, or recreational drug use. Pertinent review system: Positive for gum bleeding, shortness of breath and nonproductive cough, weakness, and easy bruising. Pertinent physical exam: Blood pressure of 111/52, pulse of 110, respiratory of 21, temperature of 98.6°, oxygen saturation 96%. Pulse did improve to 78. General: Patient appears stated age, well developed and well nourished, in no acute distress. HEENT: No cervical lymphadenopathy, thyromegaly, or bruit. Skin: No rashes, exudates, or nodules on limited skin. Pertinent labs: WBC 44,780, Hgb 5.9, Hct 18.0, Platelets 20, PT (Prothrombin Time) 19, INR (International Normalization Ratio) 1.7, pH 7.55, pCO2 28, pO2 65.4, BUN (Blood Urea Nitrogen) 45, Creatinine 1.85, Mg 2.7, total bilirubin 1.7, Blast cell % 37, Auer rods present. Clinical course: The patient was administered two units of PRBC (Packed Red Blood Cell) and 1 unit of platelets. Oncology was consulted as

the patient had acute promyelocytic leukemia, a hematological emergency. ATRA (all-trans retinoic acid) 60-mg q.12h was initiated. Comment: When Acute promyelocytic leukemia is suspected, treat IMMEDIATELY without delay with all-trans retinoic acid (ATRA). Confirmation with molecular detection of PML-RARA fusion can be performed after initiation of therapy. There are three stages in therapy, induction, consolidation, and maintenance. Patients with APL will be assumed to have DIC until proven otherwise, therefore the following labs must be monitored closely: CBC, fibrinogen, PT, PTT, and INR every 6 hours. CMP (Complete Metabolic Panel), magnesium, and phosphate must be monitored every 12 hours to assess for tumor lysis syndrome. The patient requires transfer to a tertiary center immediately. Conclusion: Acute promyelocytic leukemia is exceedingly rare, and recognition of symptoms and diagnosis is essential for treatment in an acute setting. Complications from the disease and treatment must be considered while taking care of patients.

Context: Acute promyelocytic leukemia is exceedingly rare. Recognition of symptoms, diagnosis, and acute management are extremely critical to survival. Case report: 66-year-old African American male presented to the emergency room with a chief complaint of a 3-day history of shortness of breath, fatigue, and weakness. Symptoms were worsened with exertion. The patient has a history of unintentional weight loss of 40 lbs. over the past 9 months. The patient reported he easily bruises and has excessive gum bleeding when he brushes his teeth. CBC (Complete Blood Counts) showed a high percentage of blast cells, and pathology showed Aura rods. Past medical history: Essential hypertension, Urinary incontinence, Seasonal allergies, Erectile dysfunction. Past surgical history: Penile pump in 2001. Family History: Father deceased, pancreatic cancer; Mother living, gastric cancer; Paternal uncle deceased, colon cancer; Sister living, CML (Chronic Myeloid Leukemia). Outpatient medications: Amlodipine Besylate 7.5 mg P.O. Daily, Atenolol 50 mg P.O.

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