Question

A 25-year-old male presented with low hemoglobin, platelet count of 25,000/mL, gum bleeding, and raised PT & aPTT. The image of his peripheral smear is given below. What is the likely diagnosis?

• A. AML with t(8;21)
• B. AML with inv(16)
• C. AML with t(15;17)
• D. AML with t(11;22)

Answer 1

The Correct Option is C

The presented case involves a 25-year-old male with the following clinical findings:

• Low hemoglobin
• Platelet count of 25,000/mL
• Gum bleeding
• Raised Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT)

The peripheral smear image, although not shown here, is crucial for diagnosing hematological disorders. In this scenario, the clinical presentation aligns with a particular subtype of Acute Myeloid Leukemia (AML).

Let us analyze the options:

• AML with t(8;21): Often associated with younger patients, it presents with specific cytogenetic abnormalities but does not typically present with the coagulopathy described.
• AML with inv(16): Another cytogenetic variant of AML, not the classic presentation associated with bleeding or coagulopathy.
• AML with t(15;17): Known as Acute Promyelocytic Leukemia (APL), this subtype is classically associated with severe coagulopathy due to disseminated intravascular coagulation (DIC), which leads to bleeding, including gum bleeding, as seen in this patient. Raised PT and aPTT are indicative of this condition.
• AML with t(11;22): This is not a recognized cytogenetic abnormality for AML.

Based on the characteristic presentation of bleeding and coagulation abnormalities, the likely diagnosis is AML with t(15;17), which is consistent with Acute Promyelocytic Leukemia (APL). Immediate identification is crucial due to the associated coagulopathy that requires prompt treatment with all-trans retinoic acid (ATRA).