Clinical Analysis of 9 Misdiagnosed or Missed Diagnosis Patients with Atypical Acute Leukemia

MIU Xiao-juan; DENG Rui; FAN Fang-yi; HE Guang-cui; SU Yi

doi:10.3969/j.issn.1002-3429.2017.06.005

Abstract：Objective To investigate causes of atypical acute leukemia (AL) in order to improve levels of diagnosis and treatment.Methods Clinical data of 9 AL patients having atypical symptoms as primary manifestation admitted during January 2008 and May 2016 was retrospectively analyzed.Results The misdiagnosed and missed diagnosis time of the 9 patients was (12.20±8.36)d.Among the 9 patients, 2 patients were misdiagnosed as having agranulocytosis;1 patient was misdiagnosed as having sepsis;1 patient was misdiagnosed as having thrombocytopenic purpura;1 patient was misdiagnosed as having rheumatic fever associated by rheumatic arthritis;among 4 missed diagnosis patients, 2 patients were diagnosed as having peptic ulcer associated by urticaria;1 patient was diagnosed as having chronic gastritis associated by urticaria;1 patient was diagnosed as having hookworm disease associated by secondary anemia.All patients received bone marrow aspiration cytological examination, acute lymphoblastic leukemia was confirmed in 4 patients, acute basophilic leukemia was confirmed in 3 patients, and acute myeloblastic leukemia was confirmed in 2 patients.After diagnosis, 2 patients were treated with bone marrow transplantation, and 7 patients were treated with chemotherapy and symptomatic treatment, and then all patients were discharged after improving conditions.All patients had stable conditions without recrudescence during 3 years of follow-up.Conclusion Clinicians should consider the possible of Al for patients with atypical symptoms and abnormal hematological system as primary manifestation, and give related examinations early in order to decrease misdiagnosed and missed diagnosed rates by diagnosis and treatment early and prognosis improvement.