Hemophagocytosis in acute myeloid leukemiaA 63-year-old man with acute myeloid leukemia (AML) and treated with venetoclax and azacytidine, presented to the emergency department with fever, shortness of breath and gum bleeding. Laboratory evaluation showed pancytopenia; prolonged thrombin time with hypofibrinogenemia, elevated D-dimer and hyperferritinemia (29,000 µg/ L). Bone marrow smear revealed blastic infiltration with hemophagocytosis by histiocytes (panel A), macrophages (Panel B) and blasts (Panels C and D), (Figure 1).
Figure 1
Bone marrow aspirate showing hemophagocytosis by (A) histiocytes, (B) macrophages and (C, D) infiltration with hemophagocytosis by monocytic blasts (Wright-Giemsa stain, 100x).
Bone marrow aspirate showing hemophagocytosis by (A) histiocytes, (B) macrophages and (C, D) infiltration with hemophagocytosis by monocytic blasts (Wright-Giemsa stain, 100x).
Salvage chemotherapy was initiated, but the patient died 28 days after presentation. Hemophagocytic lymphohistiocytosis can be diagnosed in up to 10% of patients with AML,1 and is associated with poor outcomes.1,2
References
- 1 Delavigne K., Bérard E., Bertoli S., Corre J., Duchayne E., Demur C., et al. Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy. Haematologica. 2014;99(3):474-80.
- 2 Hatano K., Nagai T., Matsuyama T., Sakaguchi Y., Fujiwara S., Oh I., et al. Leukemia cells directly phagocytose blood cells in AML-associated hemophagocytic lymphohistiocytosis: a case report and review of the literature. Acta Haematol. 2015;133(1):98-100.
