03-03-2007, 10:35 AM
A 42-year-old woman presents with epistaxis and gum bleeding. Physical examination is remarkable for a temperature of 38°C (100.4°F) and petechiae on the lower extremities. Laboratory evaluation includes a hematocrit of 29%, platelet count of 15,000/L, and WBC of 2100/L (differential including 22% blasts, 30% promyelocytes, 20% lymphocytes, 10% monocytes, 2% myelocytes, and 3% metamyelocytes). PT is 15 s and PTT is 55 s. Bone marrow examination discloses a hypercellular marrow infiltrated with myeloblasts and heavily granulated promyelocytes. Myeloperoxidase stain of a bone marrow aspirate smear is markedly positive and demonstrates numerous intracellular rodlike forms. The patient is begun on all-trans retinoic acid. Which of the following is the most likely complication of this therapy?
A) Worsening of disseminated intravascular coagulopathy
B) Infection during neutropenia
C) Respiratory distress
D) Uric acid nephropathy
E) Mucositis
A) Worsening of disseminated intravascular coagulopathy
B) Infection during neutropenia
C) Respiratory distress
D) Uric acid nephropathy
E) Mucositis