Chronic deep venous thrombosis as the presenting manifestation of acute promyelocytic leukaemia : A case report
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Abstract
Background: Acute promyelocytic leukaemia (APL) usually presents with disseminated intravascular coagulation or hyper-fibrinogenolysis followed by bleeding manifestation. But thrombosis as a presenting manifestation is less often reported in APL.
Objectives: We describe an uncommon case of chronic deep venous thrombosis (DVT) of lower limb with unsuspected APL.
Results: A 27 year old male presented with DVT and was treated with enoxaparin and later Dabigatran for 2 months without any improvement. A routine haematological assessment showed Leucopenia with few circulating abnormal promyelocytes. The bone marrow assessment with flow cytometry and molecular studies established the diagnosis of APL. Patient was never having any bleeding manifestation despite on anticoagulation too. A thrombophilia work up revealed presence of hyper-homocysteinemia and mild lupus anticoagulant in addition to APL as a prothrombotic event.
Conclusion: DVT with leukopenia warrants further investigation to rule out Acute Promyelocytic Leukaemia. It includes a thorough peripheral smear examination to look for few circulating abnormal promyelocytes, bone marrow studies and molecular /cytogenetics analysis.
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