Snapshot A 63-year-old man presents with fever, increasing fatigue, and actively bleeding gums. Physical exam also reveals several oral mucosal petechiae. His CBC reveal decreased platelet and hemoglobin. His PT and PTT are elevated with low fibrinogen. Peripheral blood smear shows blasts and schistocytes. His D-dimer level is elevated. He is diagnosed with DIC and given fresh frozen plasma. He is referred to a hematologist-oncologist. Introduction Acute leukemia resulting in bone marrow failure from neoplastic proliferation Subtypes login to view 11 more bullets Epidemiology Median onset 65 years of age Risk factors login to view 5 more bullets Presentation Symptoms of pancytopenia (high WBC count but WBCs are dysfunctional) login to view 4 more bullets Physical exam login to view 4 more bullets STUDIES Best initial test - peripheral blood smear login to view 1 more bullet Most accurate test login to view 1 more bullet Bone marrow biopsy with cytogenetics login to view 2 more bullets Labs - CBC login to view 3 more bullets Differential Diagnosis ALL Myelodysplastic syndrome CML blast crisis Leukemoid reaction Treatment Initial treatment with chemotherapy login to view 2 more bullets Bone marrow transplant after remission login to view 1 more bullet All-trans-retinoic acid (ATRA) to those with M3 (APL) Complications Febrile neutropenia DIC (especially with APL) Gout Tumor lysis syndrome Prognosis Prognostic indicator is cytogenetics 90% complete response rate from initial chemotherapy in those with good cytogenetics Relapse rate > 50% with median survival 3-12 months