A case with acute myelofibrosis and acute promyelocytic leukemia.

A 65-year-old man was admitted to a provincial hospital repeatedly over a period of years with a history of weakness, tiredness and progressive anemia. One occasion a bone marrow aspiration was found to contain normal marrow elements. On admission four months later, the patient was pale with pitting edema on both legs. His liver was barely palpable and the spleen was palpable 2 cm below the costal margin. He was anemic and peripheral blood showed anisopoikilocytosis, burr cells, ovalocytes and macrocytosis. The platelet level was very low, with some giant cells. The white blood cell count was normal, with some immature granulocytes. Bone marrow biopsy confirmed the diagnosis of acute myelofibrosis. The patient had very high levels of serum vitamin B12 and vitamin B12 binding proteins, especially transcobalamin I. After treatment with blood transfusion and prednisolone, his white cell count increased considerably. He died nine days after admission because of bronchopneumonia. This patient is an example of the simultaneous occurrence of acute myelofibrosis and acute promyelocytic leukemia that can terminate as acute myeloblastic or other stem – cell leukemia.