Lab Med Online.  2019 Jan;9(1):26-29. 10.3343/lmo.2019.9.1.26.

Promyelocytic Leukemoid Reaction: Unusual Findings in a Patient with Sepsis

• Kim YK

• KMID: 2430207
• DOI: http://doi.org/10.3343/lmo.2019.9.1.26

Abstract

Neutrophilic leukemoid reaction may occur in many situations, including hemolysis, malignancy, infection, and exposure to certain toxins. It usually shows morphological overlap with chronic myeloid leukemia in which promyelocytes are not majorly associated. Here, we present a case of promyelocytic leukemoid reaction in a patient with sepsis. A 28-year-old man was admitted for renal stone removal. After percutaneous nephrolithotomy, his condition deteriorated with fever (37.8℃), tachycardia (130/min), acute renal failure, pleural effusion, and pulmonary edema. Complete blood count indicated a white blood cell count of 73.39×10⁹/L including 82% promyelocytes, hemoglobin 8.9 g/dL, and platelet count of 85×10⁹/L. A bone marrow aspirate showed that promyelocytes accounted for 73.8% of all nucleated cells. Following bone marrow examination, treatment with all-trans retinoic acid (ATRA) was started immediately. Reverse transcription polymerase chain reaction (RT-PCR) study revealed the absence of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) and other RARA (retinoic acid receptor alpha) rearrangements. Once the chromosome analysis of bone marrow cells demonstrated the normal karyotype, ATRA was discontinued.

Keyword

Leukemoid reaction; Promyelocytic leukemoid reaction; Sepsis; Acute promyelocytic leukemia; RARA rearrangement; ATRA

MeSH Terms

Acute Kidney Injury
Adult
Blood Cell Count
Bone Marrow
Bone Marrow Cells
Bone Marrow Examination
Fever
Granulocyte Precursor Cells
Hemolysis
Humans
Karyotype
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Promyelocytic, Acute
Leukemoid Reaction*
Leukocyte Count
Nephrostomy, Percutaneous
Neutrophils
Platelet Count
Pleural Effusion
Polymerase Chain Reaction
Pulmonary Edema
Reverse Transcription
Sepsis*
Tachycardia
Tretinoin
Tretinoin

Figure

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  Fig. 1. Bone marrow aspirate smear showing promyelocytes with Auer rods.

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  Fig. 2. Medication and patient progress. Abbreviations: CRO, ceftriaxone; CIP, ciprofloxacin; P/T, piperacillin/ tazobactam; VAN, vancomycin; MEM, meropenem; FLC, fluconazole; ACV, acyclovir; TMP/SMX, trimethoprim/sulfamethoxazole; MPS, methylprednisolone; ATRA, all-trans retinoic acid.

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