Pleurisy and Peripheral Blasts

Today, Dr. Eric Lu provided a fascinating case of acute myeloid leukemia presenting with left pleuritic chest pain and left shoulder pain. A sample of the interesting take-aways:

  • Peripheral blasts are NEVER normal-->emergent Heme consult
  • Common complications of AML for which to screen:
    1. DIC --> INR, PTT, Plt, Fibrinogen
    2. TLS --> K, Cr, Phos, Cal, Uric Acid
    3. Leukostasis --> WBC >50-100k + symptoms (neuro findings, pulm findings)
    4. Functional neutropenia --> Viral, fungal, bacterial ppx. Treat fevers as neutropenic fever. Place in isolation.
  • Prognosis for AML is heterogeneous and dependent primarily on tumor genetics, age of patient, and response to initial induction
>1% peripheral blasts warrants hematology consultation

>1% peripheral blasts warrants hematology consultation

Promyelocytes on peripheral smear: bilobed nucleus with hypergranularity (there is a hypogranular variant) APL accounts for 5-8% of new AML cases. Important to recognize because: * Life threatening coagulopathy is more common in APL * Unique response to all-transretinoic acid-based therapy.  * Cure rates >80% if caught prior to terminal complications and requires a high index of suspicion to diagnose early

Promyelocytes on peripheral smear: bilobed nucleus with hypergranularity (there is a hypogranular variant)

APL accounts for 5-8% of new AML cases. Important to recognize because:

* Life threatening coagulopathy is more common in APL

* Unique response to all-transretinoic acid-based therapy. 

* Cure rates >80% if caught prior to terminal complications and requires a high index of suspicion to diagnose early