Nasim SALIMIAGHDAM, Vivian Arguello GUERRA, Kristina ZARKUA
Introduction: Acute promyelocytic leukemia (APL; M3) is a distinct subtype of acute myeloid leukemia characterized by fusion of the promyelocytic leukemia (PML) gene with retinoic acid receptor alpha (RARA), most often resulting from the t(15;17)(q24;q21) translocation. APL is uniquely associated with disseminated intravascular coagulation and life-threatening bleeding, making it a hematologic emergency. Despite excellent long-term outcomes with all-trans retinoic acid–based therapy, early mortality remains significant, particularly when diagnosis or treatment is delayed
Case Presentation: A 59-year-old man with multiple comorbidities presented with gastrointestinal bleeding, hematuria, mucosal hemorrhage, and pancytopenia. Laboratory evaluation demonstrated overt disseminated intravascular coagulation with severe thrombocytopenia and hypofibrinogenemia. Peripheral blood smear and bone marrow examination revealed abnormal promyelocytes containing Auer rods. Cytogenetic and molecular analyses confirmed acute promyelocytic leukemia with t(15;17)(q24;q21) and an additional abnormality of trisomy 8. Owing to profound coagulopathy and high bleeding risk, the patient required aggressive transfusional support and was transferred to a tertiary leukemia center for definitive care.
Conclusion: This case emphasizes the importance of early recognition of APL in patients with unexplained bleeding and cytopenias. Rapid cytogenetic confirmation and immediate initiation of ATRA are essential to reduce early mortality. Standardized referral pathways are essential to improve outcomes and reduce deaths.
Keywords: Acute promyelocytic leukemia (APL); PML–RARA fusion; t(15;17)(q24;q21); Trisomy 8; Disseminated intravascular coagulation (DIC); Pancytopenia; Gastrointestinal/mucosal bleeding; Early diagnosis; Cytogenetic testing
https://doi.org/10.59854/dhrrh.2026.4.3.105
Cite this article
Salimiaghdam N., Guerra V.A, Zarkua K., The Overture of DIC: An APL Case from Community to Cure. DHRRH, 2026, 6(2), https://doi.org/10.59854/dhrrh.2026.4.3.105
