Thenewenglandjournalofmedicine
ImagesinClinicalMedicine
ChanaA.Sacks,M.D.,Editor
AuerRods
69-year-oldmanwasreferredtoourmedicalcenterfortheSarahW.Gordon,D.O.
evaluationandtreatmentofneutropeniaandanemia.Thecompleteblood
VirginiaCommonwealthUniversity
Acountshowedawhite-cellcountof1000permicroliter(referencerange,SchoolofMedicine
Richmond,VA
4800to10,800permicroliter),with10%neutrophils(absoluteneutrophilcount,
100)andahemoglobinlevelof10.6gperdeciliter(referencerange,14to18gper
GeoffreyW.Krystal,M.D.,Ph.D.
deciliter).Bonemarrowaspirationrevealed5%blastsand65%promyelocytes;
HunterHolmesMcGuireVAMedicalCenter
manypromyelocyteshadprominentAuerrods(arrows)andmitoticfigures.The
Richmond,VA
patientwasstartedonall-transretinoicacid.Fluorescenceinsituhybridizationgeoffrey.krystal@va.gov
showedatranslocationinvolvingchromosomes15and17,leadingtotheproduction
ofafusionprotein,promyelocyticleukemia–retinoicacidreceptoralpha,which
confirmedadiagnosisofacutepromyelocyticleukemia(APL).Auerrodscanbeseen
inmostsubtypesofacutemyeloidleukemia,butwhensuchrodsareabundant,they
suggestAPL.Thisformofleukemiaisassociatedwiththedevelopmentofdissemi-
natedintravascularcoagulation,ariskthatcanbemitigatedbytheearlyinitiation
oftreatmentwithall-transretinoicacid.Thepatientcompletedinductionandcon-
solidationtherapieswithall-transretinoicacidandarsenictrioxideandwasincom-
pletemolecularremissionatfollow-up10monthslater.
DOI: 10.1056/NEJMicm1612344
Copyright?2017MassachusettsMedicalSociety.
2065
nengljmed376;21nejm.orgMay25,2017
TheNewEnglandJournalofMedicine
Downloadedfromnejm.orgbylililyuonJune11,2017.Forpersonaluseonly.Nootheruseswithoutpermission.
Copyright?2017MassachusettsMedicalSociety.Allrightsreserved. |
|
