Case-Letter| Volume 351, ISSUE 3, P317-318, March 2016

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An Unusual Case of Acute Promyelocytic Leukemia Presenting With Hypoplastic Bone Marrow and Pancytopenia

      A 69-year-old White woman was referred to our clinic for evaluation of pancytopenia. She was found to have leukopenia (1.2 × 103/mm3) and thrombocytopenia (85 × 103/mm3) 6 months before her clinic visit, but did not receive further workup. She presented with worsening fatigue, gingival bleeding and recurrent cellulitis of 3 months׳ duration. Her blood counts at the time of clinic visit showed severe pancytopenia with white blood cell count of 0.9 × 103/mm3, platelet count of 21 × 103/mm3 and hemoglobin of 8 g/dL. Peripheral smear showed macrocytosis and poikilocytosis but no blast forms. Her initial coagulation studies were normal. She had undergone bone marrow biopsy and aspiration by an outside hematologist 2 weeks before her clinic visit, which showed a hypoplastic marrow (10-15% cellularity) without prominent morphologic features of dyspoiesis. Flow cytometry analysis of the aspirate identified a regenerating myeloblast population accounting for less than 1% of the analyzed events. Concurrent karyotype analysis of the bone marrow aspirate revealed 46,XX,del(17)(q23)[4]/46,XX,del(1)(q32),del(17)(q23)[3]/46,XX[11] identifying 2 clonal cell lines with del 17q present in both.
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