Acute Promyelocytic Leukaemia Presenting as Bleeding in a Minor Burn Patient: A Case Report
In burn patients with severe cytopaenias, consider alternative diagnoses like acute promyelocytic leukaemia, as peripheral blood smear analysis can be crucial.
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This case report discusses a 12-year-old female burn patient who presented with severe gastrointestinal bleeding and cytopaenias after a minor burn. Investigations revealed acute promyelocytic leukaemia, confirmed by fluorescence in situ hybridisation. Despite management, the patient developed multiorgan failure and died.
Abstract
Background: and Clinical Significance: When burn patients develop cytopaenias, particularly thrombocytopaenia and anaemia, the aetiology is often multifactorial but usually linked to either systemic inflammatory response syndrome (SIRS) or wound sepsis. However, haematological derangements that are disproportionate to the burn severity pose a critical red flag and should raise suspicion for alternative pathology. The potential value of peripheral blood smear analysis in identifying alternative haematological pathologies in burn patients with unexpectedly severe cytopaenias is discussed. Case Presentation: We report a retrospective case review of a 12 year old female without co-morbidities, who sustained a minor 4% total body surface area scald burn and presented to a Burn Unit with severe gastrointestinal bleeding, thrombocytopaenia, anaemia, and leucocytosis unresponsive to conventional medical therapy. Investigations included gastroscopy, thromboelastography, blood cultures, and peripheral blood smear analysis. Management included fluid resuscitation, blood transfusions, antibiotics, pantoprazole, octreotide, and renal replacement therapy. The unexpectedly severe cytopaenia and poor response to transfusion support prompted peripheral blood smear analysis, which revealed findings consistent with acute promyelocytic leukaemia , confirmed by fluorescence in situ hybridisation demonstrating t(15;17) and PML/RARA fusion. The patient was commenced on All-Trans Retinoic Acid and Daunorubicin. Despite intensive multidisciplinary management, the patient developed multiorgan failure and died. Conclusions: This case illustrates how peripheral blood smear analysis helped identify an underlying haematological malignancy in a burn patient with unexpectedly severe or disproportionate cytopaenias, underscoring the importance of a broad differential diagnosis in this clinical context.