Clinical Case Database / Category: Patient Management

A case of easy bruising

Publication details

Dr Bethan Myers, Dr Anna Dillon
Foundation Years Journal, volume 9, issue 3, p.28 (123Doc Education, London, March 2015)

Abstract

We discuss the case of a 67 year old lady who presented with spontaneous bleeding and headache. Initial blood tests demonstrated a pancytopenia and deranged clotting tests. The blood film confirmed pancytopenia and demonstrated myeloid blasts with concerning features for acute promyleocytic leukaemia (APML). An urgent CT demonstrated acute intracranial haemorrhage. She was managed with aggressive blood product support and neurosurgical intervention. She was immediately commenced on all-trans-retinoic acid and subsequently chemotherapy to treat the leukaemia. The diagnosis was subsequently confirmed on bone marrow molecular studies. She is currently in remission from her leukaemia and has no neurological sequelae. We discuss an approach to the assessment of patients with spontaneous bruising and a summary of the pathophysiology and management of patients with APML.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

ProductPriceSubscription
Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart

Authors

Dr Bethan Myers

Haematology Consultant, Departments of Haematology,
Lincoln County Hospital & University Hospitals of Leicester,
Lincoln County Hospital, Greetwell Road, Lincoln, LN2 5QY.
Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW.
bethan.myers@ulh.nhs.uk

Dr Anna Dillon (Corresponding author)

Specialist Registrar in Haematology, Department of Haematology,
QMC Campus, Nottingham University Hospitals, Nottingham, NG7 2UH.
anna.dillon@nhs.net

References

1. Rodeghiero et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. Journal of Thrombosis and Haemostasis. Volume 8, Issue 9, pages 2063–2065, September 2010.
2. Sanz et al. Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet Blood, 26 Feb 2009. Vol. 113.No.9.
3. Asou N, Adachi K, Tamura J, et al. Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic cid and chemotherapy. J Clin Oncol. 1998;16:78-85.
4. Sanz M, Martin G, Gonzalez M, et al. Risk adapted treatment of acute promyelocytic leukemia with all-trans-retinoic acid and anthracycline monochemotherapy: a multicenter study by thePETHEMA group. Blood. 2004;103:1237-1243.
5. Larson RA, Kondo K, Vardiman JW, Butler AE, Golomb HM, Rowley JD. Evidence for a 15;17 translocation in every patient with acute promyelocytic leukemia. Am J Med 1984;76:827-41.
6. Tallman M. et al. All-trans-retinoic acid in acute promyelocytic leukaemia. NEJM 1997. Vol 337. No.15
7. Breen. KA. et al Pathogenesis and management of the coagulopathy of acute promyelocytic leukaemia. British Journal of Haematology, (2011) 156, 24–36.
8. Barbui T, Finazzi G, Falanga A. The impact of alltrans-retinoic acid on the coagulopathy of acute promyelocytic leukemia. Blood. 1998;91:3093- 3102.

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.