Haematology Watch

Haematology Watch, Vol 3, Issue 2.

IMAGE OF THE ISSUE

IMAGE OF THE ISSUE 

Abbas Hashim (Iraq)

A 24 year old female with AML-M3. Started on ATRA based regime since 14 days. Now her Hb 13.8 g/dl, PCV 41.5 %, WBC 5.5 * 10^(9)/l and Platelets 89 * 10^(9)/l. Images 1-5 are from her follow-up PB smear which revealed many dysplastic neutrophils, some of it still contain Auer rods.

 

AML-M3 and -M3 variant are caused by t(15;17)(q22;q21) which results in the fusion of the retinoic acid receptor alpha (RARα) gene located at chromosome 17 with the PML gene on chromosome 15. This chimeric gene plays the major role in the differentiation block that occurs in AML-M3.

The prognosis in these patients is very good due to response to ATRA which acts by converting the PML–RARα fusion protein from a transcriptional repressor to a transcriptional activator, thus inducing terminal differentiation of the leukaemic clone.