title: Acute promyelocytic leukemia: an unusual cause of fatal secondary postpartum hemorrhage.
abstract: BACKGROUND
  Postpartum haemorrhage can rarely be associated with an underlying coagulation or haematological disorder. We wish to discuss a case of acute promyelocytic leukemia (APL) presenting as secondary postpartum hemorrhage (PPH), its clinical and pathological features and maternal outcome.
  
  
  METHODS
  We describe a 28-year-old woman who presented with secondary PPH accompanied by bleeding from gums, marked pallor, hematemesis, ecchymotic and purpuric spots all over the body, 8 days post-partum. Investigations revealed her to be having APL, a diagnosis not suspected by the referring clinic. She was given supportive therapy but died before chemotherapy could be started.
  
  
  CONCLUSIONS
  The case emphasizes the importance of suspecting, investigating and energetically treating uncommon causes such as acute leukemia when an unusually severe clinical picture in a postpartum setting suggests such a possibility. This may prove to be life saving, particularly if the leukemia happens to be APL, a cancer with a very high cure rate.
authors.affiliation: Department of Obstetrics & Gynaecology & Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India. jbsharma@eth.net
authors.forename: J B
authors.initials: JB
authors.lastname: Sharma
authors.forename: Nupur
authors.initials: N
authors.lastname: Gupta
authors.forename: N
authors.initials: N
authors.lastname: Vimala
authors.forename: Mona
authors.initials: M
authors.lastname: Anand
authors.forename: Deepika
authors.initials: D
authors.lastname: Deka
authors.forename: Suneeta
authors.initials: S
authors.lastname: Mittal
mesh_terms: D000328:Adult; D004438:Ecchymosis; D017809:Fatal Outcome; D005260:Female; D005884:Gingival Hemorrhage; D006396:Hematemesis; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000175:diagnosis; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy