Quick Review
Patient is an adult (usually older, but can also be younger) with fatigue (due to anemia) and bleeding (due to thrombocytopenia) and on CBC there is decreased hemoglobin, decreased platelets, and WBC varies (can be normal, increased or decreased). LDH will be elevated. The most important form of AML to know is acute promyelocytic leukemia (APML). On peripheral smear, AML presents with myeloblasts with Auer rods. Bone marrow biopsy will show myeloid blasts, for APML this would be atypical promyelocytes.
In AML, the bone marrow is crowded with immature myeloid cells ("blasts") preventing development of other cell types (platelets, RBCs, normal WBCs). These myeloblasts are also present in the peripheral blood in large numbers. This is why patients have fatigue (anemia), bleeding/ bruising (thrombocytopenia), increased infections (granulocytopenia).
APML can present with DIC (disseminated intravascular coagulation) which results in elevated PT and aPTT and reduced fibrinogen on coagulation studies.
For treatment, it is important to know that ATRA (all-trans-retinoic acid) is a key feature of the treatment for APML. This drug is also better known as tretinoin (isotretinoin is used to treat severe acne). This is because of pathology involving the retinoic acid receptor.
Relevant images
Auer rods
APML blood smear
APML bone marrow aspirate
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