A 32-year-old woman presents with gum bleeding and petechiae. Hemoglobin is 8 g/dL, WBC 2,100/uL, platelets 18,000/uL, prothrombin time prolonged, fibrinogen 80 mg/dL, and D-dimer markedly elevated. Peripheral smear shows abnormal promyelocytes with bundles of Auer rods. What is the most likely diagnosis?

• A Acute promyelocytic leukemia ✓
• B Acute myeloid leukemia with t(8;21)
• C Acute monocytic leukemia
• D Acute megakaryoblastic leukemia

Explanation

The combination of a coagulopathy consistent with disseminated intravascular coagulation, pancytopenia, and abnormal promyelocytes containing multiple Auer rods (faggot cells) defines acute promyelocytic leukemia, associated with t(15;17) and the PML-RARA fusion. Acute monocytic leukemia typically presents with tissue infiltration such as gingival hypertrophy, not fulminant DIC, and lacks faggot cells.

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.