Second trimester medical abortion in acute promyelocytic leukaemia

Acute promyelocytic leukaemia (APL) is a highly lethal haematological malignancy. It is rare in pregnancy and may be fatal if not managed promptly and appropriately. A woman in her 20s presented with high-grade fever at 16 weeks of her third pregnancy. She was referred to our institution due to persistent fever with pancytopenia. A peripheral blood smear revealed atypical promyelocytes with reduced red cell density and giant platelets. Bone marrow biopsy demonstrated Auer rods and faggot cells consistent with APL. Though emotionally challenged by the circumstances, the couple decided to terminate the pregnancy and receive chemotherapy. She was given arsenic trioxide and all-trans retinoic acid. Following one dose of oral mifepristone and two doses of vaginal misoprostol, she spontaneously expelled a female abortus. Her chemotherapy was completed, and 3 years on, she is currently doing well. This case describes the dilemmas in management for the couple and providers.