Fi
Adaitted on 10-2-72 ta Natfonal Cancer Institute,
Hematology and Supportive Care Branch
|
Expired on 11-15-72 from National Cancer Institute,
‘
Hematology and Supportive Care Branch
HOSPITAL COURSE:
Pe ots
Problem No. 1 - Acute Proganulocytic Leukemia:
On the morning of the second hospital day the pacient had a posterior iliac crest
bone marrow aspirate revealing decreased normal marrow elements and infiltration by
cells with prominent eosinophilic cytoplasmic granules and prominent nucleoli, Some
of these cells had Auer rods in the cytoplasm. The impression was that the marrow ~
showed changes of acute promyelocytic leukemia, A bone marrow blopsy showed hypercellularity and infileracion by abnormal cells, Despite extensive marrow involvement,
however, the patient did not have severe anemia or circulating abnormal cells when he
first presented here.
On Ocrober 12 he was discharged, feeling well, to be followed
closely in the Special Ambulatory Care Clinic. The plan was to treat him for bleeding
episodes, the appearance of blast cells in the peripheral blood, splenomegaly, or
deterioration of coagulation parameters.
j
Unfortunately, after only two days in the Outpatient Clinic, the patient's platelet
count fell co 7,000, and he developed an earache and ahd a low-grade fever, He was
therefore readmitted and on October 15 begun on therapy with cytosine arabinoside, 100 mg.
per meter squared intravenously every 12 hours, and 6-thioguanine, 90 mg. per meter
Squared orally every 12 hours, The patient's base-line prothrobin time, partial throaboplastin time, thrombin time, fibrinogen, fibrin split produccs, and factor VIII were
within the normal range; nevercheless, because of the associarion of intravascular coagula-
tion with acute progranulocytic leukemia, he was treated prophylactically with heparin,
0.5 mg. per kg. intravenously every 6 hours for the first five daya of chemotherapeutic
drugs.
On the firse day of creatment the white blood count was 1,700 with 21% neutrophils,
56% lymphocytes and 20% abnormal precursors;
platelets were 32,000 (after transfusion)
and hemoglobin 10.3. His white count remained low throughoue the remainder of his hoa{ral course, abnormal forms disappeared from the peripheral blood on che ninth day of
treatmenc; platelet transfusions were administered every two or three days in an effort
to keep the platelet count above 20,000, Serial bone marrow examinations revealed: on
day five, hyperceliular marrow with 80% abnormal cells; on day seven, hypercellular
marrow with 90% progranulocytes; on day twelve, hypercelluiar marrow with 95% progranulocytes; on day fourteen, hypercellular marrow with 82% progranulocytes; on day nineteen,
normocellular marrow with 80% progranulocytes; on the day prior to death, after twenty-two
days of treatment, a hypocellular marrow with persisting foci of abnormal promyelocytes,.
On the day prior to death the patient's hemoglobin was 8.3, white cell count, 2,100 with
100% lymphocytes, and placelerc counce 11,000. He had received 10 units of packed red
blood cells and had received platelet transfusions on 18 days of his hospical stay.
During the last two wecks cof life he had very poor increments in placelet count after
platelet transfuslons, probably because HLA identical platelecs were not available for
transfusion,
Rongelap (54)
CliniCai @&COeD
09-44-40 3
Cl) tevewes ond Physeet Enemsnetion
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