Where time is of the essence: a case of acute promyelocytic leukemia and review of the literature

Acute promyelocytic leukemia represents a medical emergency with a high rate of early mortality. It has a high predilection for disseminated intravascular coagulation and in the absence of treatment, can be rapidly fatal. Without treatment, the median survival is less than 1 month.The coagulopathy in APL is complex and can be attributed to a combination of thrombocytopenia, disseminated intravascular coagulation and hyperfibrinolysis. White blood cell count at presentation is an important predictor of early hemorrhagic death. With the discovery of all-trans retinoic acid and arsenic trioxide, acute promyelocytic leukemia has transformed from a devastating disease into one of the most curable malignancies.Patients should be monitored for the development of differentiation syndrome, seen in 25 % of patients within 2-21 days of initiation of treatment. Early death is still a key issue, particularly in the elderly population, reiterating the importance of rapid diagnosis and treatment.We report the case of a 48 year-old-male diagnosed with the microgranular variant of acute promyelocytic leukemia M3 subtype and treated with all-trans retinoic acid and arsenic trioxide who achieved complete hematological remission.