[Devil with angel wings - when vitamin A saves lives]

Area of Science:

• Hematology
• Oncology
• Internal Medicine

Background:

• Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia.
• APL is often associated with severe coagulation disorders, including disseminated intravascular consumption coagulopathy (DIC).

Observation:

• A 40-year-old male presented with hemorrhagic diathesis, ecchymosis, and oral bleeding.
• Diagnostic workup revealed disseminated intravascular consumption coagulopathy and 74% atypical promyelocytes on peripheral blood smear.

Findings:

• Bone marrow examination confirmed a microgranular variant of acute promyelocytic leukemia.
• The patient received a combination therapy including all-trans retinoic acid (ATRA), arsenic trioxide (ATO), and idarubicin.
• The patient achieved complete remission without severe complications.

Implications:

• Early diagnosis and rapid initiation of therapy, including ATRA and coagulation management, are critical for improving prognosis in APL.
• This case highlights the successful management of a potentially fatal hematologic malignancy with prompt and aggressive treatment.
• The microgranular variant of APL requires specific therapeutic approaches for optimal outcomes.