Figure 54. Left: [mmacure myelocytic cells (many promyelocytes) in marrow of subject No. 34, 6 weeks before death. x 1650, Aight: Promyelocytes with Auer rods were numerous. * 1630. During the 1972 annual examination the subject was found to have a WBC of 2000 and a platelet count of 120,000. He showed no other significant findings and appeared to be a healthy and husky 19-year-old. He was brought to BNL, where _a bone marrow examination revealed typical acute myelogenous leukemia, predominately of the pro- third molar, and a left chronic otitis media. Antleukemic medication included cytosine arabinoside, 6-thioguanine, heparin, oxacillin or cephalothin with gentamicin, and later ampicillin. He received blood and platelet transfusions, some from an older brother flown in from the Marshall Islands, Figure 51). He was transferred to the National Cancer Institute at Bethesda, where examination resulted in few physical findings besides the bone marrow changes noted.* He had slight inflammation of the pharynx, periodontitis around the right veloped signs of a hemorrhagic diathesis with marked hemithorax. He was placed in a respirator, myelocytic type with numerous Auer rods (see *Drs. Edward S. Henderson, James Mabry, Joan Buil, Maria Tomaszewski, and Jacqueline Peng of the National Cancer Institute and Dr. Gundabhakcha Chikkapa of Brookhaven Naconai Laboratory assisted with this study. but compatible platelets were not available. Plate- let levels continued low, and within 2 weeks he debut his condition worsened, and he died 6 weeks after admission. (See Appendix 11 for hospital summary.) The principal autopsy findings included acute myeloblastic (promyelocytic?) leukemia in spleen, lymph nodes, arachnoid, and bone marrow. There had been massive pulmonary hemorrhagebilaterally and inflammationof the parotid gland. It was ° Table 36 Difference in Mean Peripheral Blood Levels Between Subject With Leukemia (No. 54) and Exposed Peers 1954 Exposed peers Leukemia case 1955-72 Exposed peers Leukemia case IOGbIol WBC (x 1073) Neut. (10-3) 7.7 5.7 (—26%) 4.1 2.5 (—39%) 3.0 2.8 ( —6%) 3.8 3.5 8.2 6.5 (—21%) 2.7 ( —30%) Lymph. (1073) 3.1 (—11%) - Plate. ( x 1073) Het., % 246 187 (—24%) 37.3 36.4 ( —2.5%) 293 271 ( 7.5%) 39.2 40.5 ( +3%)