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Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 12-16

Acute Myeloid Leukaemia in a Patient with Sickle Cell Disease: A case report and literature review

1 Department of Haematology, Kaduna State University, Nigeria
2 Department of Haematology Ahmadu Bello University, Nigeria
3 Department of Community Medicine, Kaduna State University, Nigeria

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Introduction: The coexistence of sickle cell disease (SCD) and haematologic malignancies is not a common occurrence. Improvement in management of SCD and a consequent increase in the life expectancy has increased the risk of occurrence of haematologic and other malignancies in them. Aim: To report the coexistence of Acute Myeloid Leukaemia (AML) and SCD in the same patient. Method: The patient's clinical case notes were reviewed and analysed, as well as medline search on relevant literature. Case Report: A 24year old male with SCD (HbSC) presented with a history of bone pains, fever, sore throat, cough and headache. Examination revealed pyrexia, jaundice and crepitation in the left lung. Haemogram showed anaemia, lymphocytosis with atypical forms and asymptomatic hrombocytopenia (100x109/L). He was treated for a vaso-occlusive episode secondary to lobar pneumonia. Three weeks later, he represented with a persistence of symptoms, increasing white blood cell count (from 2.5x109/L to 28x109/L) and thrombocytopenia(51x109/L). Blood and bone marrow films showed a predominance of myeloblasts with irregular nuclei and prominent nucleoli (>25%), consistent with Acute Myeloid Leukaemia(French-American-British (FAB) M0/M1 AML). Further characterization could not be done. Induction of remission was started using intravenous Daunorubicin and Cytosine Arabinoside(DA 3+7 regimen) at 25mg/m2 for three days and 50mg/m2 12-hourly for seven days, respectively, with the possibility of a stem cell transplantation borne in mind. During therapy, he developed thrombocytopenia (platelet count (12x109/L) and fever (temperature; 39°C). His symptoms worsened with development of sub-conjunctival haemorrhage, epistaxis, bleeding from the gum and altered sensorium. He succumbed to the disease on day 10th of chemotherapy. Conclusion: The co-existence of a haematologic malignancy and SCD is not common and remains a challenge in resource constraint settings. Examination of the peripheral blood film may be the first indicator of such an occurrence. There is a need to develop both diagnostic and treatment protocols for the management of haematologic malignancies in resource-poor settings.

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