Continuing the experience of a patient in the April 1 Blood Work, a 59-year-old man with chronic myelomonocytic leukemia developed painful legs 2 months after receiving a second opinion. These symptoms were treated with anti-inflammatory agents. Ten days later, he noted bleeding in his mouth. In the emergency room, boggy bleeding gums were found. A complete blood count still showed mild anemia, but now with moderate thrombocytopenia and an increase in the white blood count to 39 × 109/L. The gingival bleeding was diagnosed as periodontal disease and he was referred back to his hematologist. He did not comply, and 4 days later he became comatose, was admitted, and died.
On his final admission, he had petechiae, purpura, and further enlargement of the spleen. The white blood cell count was 120 × 109/L. The platelets were 21 × 109/L with no coagulation abnormities. A peripheral smear affirmed the suspected conversion to acute leukemia.
Earlier on, staging and an assessment for high risk markers might have been performed. Most of these patients suffer from or succumb to the complications of cytopenias before any conversion to acute leukemia. Whether earlier staging of this patient would have prompted earlier antileukemic therapy is unclear. It is also uncertain if the eventual outcome would have been any different.
Continuing the experience of a patient in the April 1 Blood Work, a 59-year-old man with chronic myelomonocytic leukemia developed painful legs 2 months after receiving a second opinion. These symptoms were treated with anti-inflammatory agents. Ten days later, he noted bleeding in his mouth. In the emergency room, boggy bleeding gums were found. A complete blood count still showed mild anemia, but now with moderate thrombocytopenia and an increase in the white blood count to 39 × 109/L. The gingival bleeding was diagnosed as periodontal disease and he was referred back to his hematologist. He did not comply, and 4 days later he became comatose, was admitted, and died.
On his final admission, he had petechiae, purpura, and further enlargement of the spleen. The white blood cell count was 120 × 109/L. The platelets were 21 × 109/L with no coagulation abnormities. A peripheral smear affirmed the suspected conversion to acute leukemia.
Earlier on, staging and an assessment for high risk markers might have been performed. Most of these patients suffer from or succumb to the complications of cytopenias before any conversion to acute leukemia. Whether earlier staging of this patient would have prompted earlier antileukemic therapy is unclear. It is also uncertain if the eventual outcome would have been any different.
Many Blood Work images are provided by the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas images and images of case studies. For more information or to contribute to the Image Bank, visit www.ashimagebank.org.
