Chronic Myeloid Leukemia with Pancytopenia in a 30-year Old Male: Challenges in Care
We report a case of chronic myeloid leukemia (CML) of a 30-year-old man who presented to a University Teaching Hospital with a history of spontaneous epistaxis associated with generalized body weakness and on and off right-sided chest pains, palpitations, fatigue, hyperhidrosis, and loss of weight. He is a known patient who had been on treatment for a period of 7 months with 400mg of imatinib. He presented with a nasal pack, pallor of grade 2, and splenomegaly. His labs showed pancytopenia, with severe thrombocytopenia and had a working diagnosis established through examination of a bone marrow aspirate. A more definitive diagnosis could not be attained though due to the unavailability of molecular techniques such as reverse transcription PCR (RT-PCR) for the demonstration of the BCR-ABL gene. The case also presented a management dilemma in terms of its progression and the deterioration of the patient despite being fairly compliant and receiving appropriate treatment.