Acute Promyelocytic Leukemia Clinical Presentation

Updated: Mar 19, 2021
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Most of the signs and symptoms of acute promyelocytic leukemia (APL) are also seen in cases of acute myelogenous leukemia (AML). These include the following:

  • Fatigue, weakness, and dyspnea related to anemia

  • Easy bruising or bleeding caused by thrombocytopenia or coagulopathy

  • Fever and infection related to leukopenia

Most patients with APL present with pancytopenia. About 10-30% of patients present with leukocytosis. [20]

APL differs from AML in that most patients present with coagulopathy. The coagulopathy has been described as disseminated intravascular coagulation (DIC) with associated hyperfibrinolysis. APL has been associated with low levels of plasminogen, alpha2-plasmin inhibitor, and plasminogen activator inhibitor 1 found in fibrinolytic states. There is increased expression of annexin II, a receptor for plasminogen and plasminogen-activating factor, on the surface of leukemic promyelocytes. [21] This leads to overproduction of plasmin and fibrinolysis.

It is important to treat the coagulopathy as a medical emergency. In 40% of untreated patients, pulmonary and cerebral hemorrhages can occur. It takes 5-8 days for coagulopathy to improve with treatment.


Physical Examination

The physical examination can reveal pallor, petechiae, and areas of ecchymoses. Bleeding from the gums may be evident. A flow murmur can be heard in patients with severe anemia. Neurologic deficits or headaches may be present if central nervous system (CNS) involvement has occurred.