Abstract
A 23-year-old house wife on the 7 th month of gestation was admitted to the Ichikawa Hospital on July 22, complaining of severe gingival bleeding since the end of June. Physical examination revealed marked anemia and ecchymoses. Atypical promyelocytes were 84% of peripheral WBC and 88.4% of bone marrow cells. Normal ESR, thrombocytopenia, hypofibrinogenemia and reduced coagulation factors were observed. but hyperfibrinolysis was not present and ethanol gel test was positive. Leukemic cells lysed the fibrin plate markedly.
The patient was treated under diagnosis of acute promyelocytic leukemia, but on the 26 th hospital day the disappearance of the fetal heart sound was noticed in the morning, and the patient died in the evening of the same day. Autopsy revealed proliferation of atypical promyelocytes, marked bleeding in several organs and bilateral renal cortical necrosis with fibrin thrombi in the glomerular capillaries.
The pathogenesis of the marked hemorrhagic tendency with the hypofibrinogenemia in this case was considered to be mainly the intravascular coagulation which had, been reported in some cases of promyelocytic leukemia. In addition to the promyelocytic leukemia, pregnancy and fatal death might also have participated in this phenomenon.
