Acute promyelocytic leukemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Laboratory Findings

• Anemia: Anemia refers to decreased red blood cell production, which results in low hemoglobin content in the peripheral blood. Hemoglobin values are typically less than 10 g/dl in most patients with acute promyelocytic leukemia. The degree of anemia corresponds with the amount of bone marrow infiltration by leukemic cells. Patients with severe or advanced leukemia will usually have severe anemia. Severe anemia can result in profound fatigue, pallor, and shortness of breath.
• Thrombocytopenia: Thrombocytopenia refers to low platelet count. The platelet count is usually less than 150,000 cells per microliter. Low platelet count in patients with acute promyelocytic leukemia is typically due to two reasons. Firstly, leukemic cell infiltration in the bone marrow results in disruption of normal megakaryocyte production with decreased platelet production. Secondly, coagulopathy (disseminated intravascular coagulation) results in platelet consumption and therefore a low platelet count. This latter reason is unique to acute promyelocytic leukemia compared to other types of leukemia. The degree of thrombocytopenia also confers prognostic value in acute promyelocytic leukemia: platelet counts lower than 40,000 cells per microliter carries a worse prognosis than platelet counts greater than 40,000 cells per microliter.
• Leukopenia: Leukopenia refers to white blood cell count below 4,000 cells per microliter. Leukopenia is common in patients with acute promyelocytic leukemia, unlike most other types of leukemia. In some cases, however, patients can have high white blood cell counts, which confers a worse prognosis. White blood cell count above 10,000 cells per microliter defines high-risk disease.
• Hypofibrinogenemia
  • From accumulation of promyelocytes in the bone marrow results in a reduction in the production of normal red blood cells.
• Either leukopenia (low white cell count) or leukocytosis (high white cell count) may be observed in the peripheral blood.