Abstract
We present here a case of AML-cuplike complicated by fibrinolytic advanced disseminated intravascular coagulation. A woman in her 30s visited another hospital for pharyngeal pain and fever. Her blood examination results showed leukocytosis, anemia and thrombocytopenia. Since acute leukemia was suspected, she was referred to our hospital. A complete blood count at our hospital showed leukocytosis (40.7 × 109/L) and 96.6% blast cells. The cuplike blast population was 11.2% in the peripheral blood. The results of coagulation tests showed fibrinolytic advanced disseminated intravascular coagulation (DIC) (FDP level, > 150 μg/mL; D-dimer level, > 150 μg/mL; SFMC level, 52.4 μg/mL; TAT level, 58.9 ng/mL; and PIC level, 17.2 μg/mL). In bone marrow smears, blast cells were the majority, but cuplike cells were hardly seen. Flow cytometric analysis revealed that the blast cells were positive for CD13, CD33, and MPO and negative for CD34 and HLA-DR. Chromosomal analysis revealed a normal karyotype, and FLT3-ITD was detected by polymerase chain reaction (PCR). On the basis of these results, the patient was diagnosed as having AML-cuplike. There was a very small cuplike blast population in the bone marrow in this patient. Thus, the observation of not only bone marrow smears, but also the peripheral blood smears was important for the diagnosis of AML-cuplike. Since the coagulation and fibrinolysis changes of AML-cuplike are not fully understood, the accumulation of many cases is necessary.
