The Rods

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British Society for Haemtology – Haematology images


A 52-year-old Caucasian man with no significant medical condition was seen as an urgent care patient with complaints of diarrhoea, which had been ongoing for about three months, cough and difficulty breathing for about a month and a one-week history of sore throat. He was prescribed antibiotics and steroids and had blood work drawn which showed 79% blasts with morphology (Auer rods/faggot cell) consistent with acute promyelocytic leukaemia (APL). He was promptly admitted to hospital and started on All trans retinoic acid (ATRA). Peripheral blood flow cytometry was negative for CD34 and HLA-DR and FISH (fluorescent in situ hybridisation) was positive for PML: RARA gene re-arrangement. Bone marrow biopsy was promptly performed and morphology and cytogenetics were consistent with APL. He was started on induction chemotherapy with ATRA, Arsenic trioxide and idarubicin with an aim for complete response and monitored closely for differentiation syndrome and disseminated intravascular coagulopathy.