A 32-year-old woman presents with gum bleeding and petechiae over 3 days. CBC: Hb 9 g/dL, WBC 4,500/μL, platelets 18,000/μL. PT and aPTT are prolonged, fibrinogen is 80 mg/dL, and D-dimer is markedly elevated. Bone marrow shows abnormal promyelocytes with bilobed nuclei and heavy azurophilic granules. Which is the most appropriate immediate therapy alongside supportive blood products?

• A Imatinib
• B Rituximab
• C Hydroxyurea
• D All-trans retinoic acid ✓

Explanation

The combination of DIC with thrombocytopenia and marrow packed with abnormal promyelocytes defines acute promyelocytic leukaemia, driven by PML-RARA from t(15;17). All-trans retinoic acid binds the fusion receptor, releases differentiation blockage, and rapidly corrects the coagulopathy, so it must start immediately on suspicion before genetic confirmation. Imatinib targets BCR-ABL and has no role here, which kills that distractor.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.