Case Archive
 
Hematology
Ref. # 17518

A 33 year old Ohio man with Acute Promyelocytic Leukemia (APL) was found to have a thyroid mass. A thyroidectomy revealed mixed papillary and follicular thyroid carcinoma. Chemotherapy was tolerated well. A CBC three months later was normal. Eight months later a thyroid scan was interpreted as suspicious for metastatic disease; a CT scan was normal. Chemotherapy was resumed. One month later the patient was diagnosed with moderately severe pancytopenia. A CBC showed hemoglobin 9.2, WBC 1100, platelet count 88,000--all significant decreases from six months prior. The patient complained of headaches; an MRI was negative. Three weeks later the patient was diagnosed with advanced pancytopenia. Hemoglobin was 6.4, WBC 500, platelet count 28,000. He was admitted and received two units of packed red blood cells. Treatment included G-CSF, 480 micrograms per day. The patient was readmitted four days later with a neutropenic fever. The next day he was found unresponsive as a result of a brain hemorrhage and was subsequently pronounced dead. A medQuest hematologist opined there was a negligent misdiagnosis of pancytopenia. With appropriate work-up at the time of the transfusion, the hemorrhage would have been discovered.




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