Splenic Infarction in a Case of Acute Promyelocytic Anemia

Case Presentation The patient was a previously healthy 20-year-old woman who presented with blurred vision, abdominal pain and dizziness following hemorrhoid surgery. Physical examination revealed pallor, wide peripapillary retinal hemorrhage and splenomegaly. Blood examination on admission revealed: WBC; 54×109/μl, Hb;7 gr/dl and Platelet count;16×109/μl, LDH; 3300 IU/L (normal range up to 480), Prothrombin time (PT); 19.3 sec (12-15), INR; 1.67(1-1.2), Partial thromboplastin time (PTT); 28 sec (24-45), Fibrinogen level; 287 mg/dl (200-400), Fibrin degradation product (FDP)>20 mg/L (reference range less than 10 mg/L) and D dimer >2000 ng/ml (normal <255). The Patient underwent bone marrow aspiration and biopsy which revealed hypercellular marrow with more than 95% blasts and in spite of mostly abnormal promyelocytes compatible with AML-M3. Flowcytometry revealed blasts positive for CD33, CD117 and negative for HLA-DR, myeloperoxidase staining of the blasts were strongly positive. Molecular genetic study revealed PMLRAR-α positivity by RT-PCR. Abdominal ultrasound showed splenomegaly (spleen size: 165×90 mm) with heterogeneous echo and large peripheral hypoechoic geographic lesions suggestive for infarction. Abdominal spiral CT scan showed splenic enlargement with extensive peripheral hypodensity and lack of contrast enhancement in favor of infarction (figure 1). Chemotherapy with daunorubicin, All-trans retinoic Acid (ATRA) and arsenic trioxide was initiated for the patient. He also received FFP and platelet transfusions considering the patients’ conditions and diagnosis of the patient. Initially, the Iranian Journal of Blood & Cancer