Acute promyelocytic leukemia?

Briefly, the important clinical findings were as follows: A 10 year old white girl, acutely ill, febrile and showing disseminated skin purpura. There was no visceromegaly. The disease had apparently started 3 weeks before, with epistaxis and other purpuric manifestations. Laboratory findings showed severe anemia and thrombocytopenia with a leukocyte count of 3500 per cu. mm. The differential count showed marked neutropenia with 3 promyelocytes per cent. Two bone marrow aspirates yielded hypocellular specimens. No blasts were seen but 98 per cent of the cells were promyelocytes ( fig. 1 ) . Those cells showed characteristics of both myelocytes and promyelocytes and could be considered as intermediate between the two “stages.” On the fourth day the WBC was 900 per cu. mm. Again blasts were not seen in the blood smear, but the promyelocytes had increased to 48 per cent. The bleeding manifestations had worsened, despite intravenously administered prednisolone, and the patient died on the fifth day of hospitalization. The necropsy findings were briefly as follows. Numerous hemorrhages and leukemic infiltrates were present in several viscerae. The bone marrow was hypercellular and showed a predominance of two cell types, which were tentatively classified as myelocytes and, probably, myeloblasts.