A case of platelet refractoriness in a patient with acute myelogenous leukaemia and paraplegia: management in a low resource setting
Background: Acute myelogenous leukaemia is a type of acute leukaemia more commonly seen in adults than in children and usually presents with features of anaemia, neutropoenia and thrombocytopoenia (pancytopoenia). Red cell transfusions and the use of granulocyte colony stimulating factor usually correct the anaemia and neutropoenia respectively while platelet concentrates are required for correction of thrombocytopoenia. However, some patients develop platelet refractoriness where they fail to achieve expected increment in platelet count following platelet transfusions which may be fatal because severe thrombocytopoenia may lead to bleeding into vital organs including the brain. The aim of this report is to document the management of platelet refractoriness in a patient with acute myelogenous leukaemia and paraplegia, with correction of thrombocytopoenia in a low resource setting.
Methods: Data was obtained from the case notes of a 14 year old male with acute myelogenous leukaemia and paraplegia who developed platelet refractoriness. A review of literature was done by searching on Google and PubMed.
Results: A 14 year old male who presented with pancytopoenia and paraplegia was diagnosed with acute myelogenous leukaemia. He had multiple transfusions and developed platelet refractoriness. Despite severe thrombocytopoenia and platelet refractoriness, he was commenced on chemotherapy and achieved remission.
Conclusion: Paraplegia is an uncommon presentation of central nervous system involvement in acute myelogenous leukaemia. Platelet refractoriness is a feared complication occurring in haematological malignancies. The acute myelogenous leukaemia complicated by platelet refractoriness was treated successfully in a low resource setting.
Keywords: Platelet refractoriness; Acute Myelogenous Leukaemia; Acute myeloid leukaemia; paraplegia; AML; Nigeria