Case 114 – Update 4!

Thank you for the ongoing contributions to our case. Following everyones input our 43 year old female patient has been commenced on intravenous arsenic alongside ATRA. This decision was made as her APL is considered non-high risk as initial WCC <10. However on day 8 her WCC has increased to 18.

She continues to have ongoing blood product support to achieve:

  • Plts >30-50
  • Clauss Fib >1-1.5
  • INR <1.5

Questions:

  1. What is the likely cause of the WCC rise?
  2. Do we need to alter treatment and if so how?
  3. How long would you aim to maintain the above plt / coag thresholds provided the patient doesn’t have any significant bleeding?

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