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Cerebral infarction in acute promyelocytic leukemia at initial presentation
E Saitoh1, K Sugita, H Kurosawa
1Second Department of Pediatrics, Dokkyo University School of Medicine, Tochigi, Japan.
Acta Paediatrica Japonica : Overseas Edition
|December 1, 1995
Summary
A 3-year-old girl presented with acute promyelocytic leukemia (APL) complicated by disseminated intravascular coagulation (DIC) and cerebral infarction. Despite prompt treatment, the patient succumbed to the aggressive leukemia and associated complications within a week of admission.
Area of Science:
- Hematology
- Pediatric Oncology
- Neurology
Background:
- Acute promyelocytic leukemia (APL) is a rare subtype of acute myeloid leukemia.
- Disseminated intravascular coagulation (DIC) is a serious condition characterized by abnormal blood clotting.
- Cerebral infarction, or stroke, can be a devastating complication in pediatric malignancies.
Observation:
- A 3-year-old girl presented with symptoms of unconsciousness and petechiae.
- Diagnostic imaging revealed cerebral ischemia and infarction.
- Laboratory findings included severe anemia, thrombocytopenia, and a high blast count with characteristic faggot cells in bone marrow aspirates.
Findings:
- The patient was diagnosed with acute promyelocytic leukemia (APL) at initial presentation.
- Cerebral infarction was attributed to disseminated intravascular coagulation (DIC) secondary to APL.
- Peripheral blood smear showed fragmented erythrocytes, indicative of microangiopathic hemolytic anemia, often associated with DIC.
Implications:
- This case highlights the critical importance of early recognition and aggressive management of APL with DIC in pediatric patients.
- Prompt diagnosis and intervention are crucial to prevent life-threatening complications such as cerebral infarction.
- The rapid progression and poor outcome underscore the challenges in treating aggressive pediatric leukemias with coagulopathy.