The Bleeding Burns Patient with Leukaemia

Background: Haematological derangements, including thrombocytopenia are common in burn patients and are usually attributed to SIRS or sepsis. However, rare haematological malignancies may present with similar laboratory findings, posing a diagnostic challenge. We report a case of a patient with a minor burn injury managed at home who presented six days post-injury with bicytopenia, leucocytosis and active bleeding. Initial differentials included sepsis, DIC, NSAID-induced gastrointestinal bleed, and toxic shock syndrome, with malignancy not initially suspected due to low incidence. Methods: This case is a retrospective view on the patients clinical notes, blood investigations , surgical investigation and documentation of their management. Results: Subsequent evaluation revealed Acute Promyelocytic Leukaemia (APL), a rare but potentially curable subtype of Acute Myeloid Leukaemia and this was the cause of the patient’s bleeding tendency. This poses the question of whether a blood smear should be done routinely for haematological abnormalities in burns patients too. Conclusion: Muganza et al [1] demonstrated that platelet decline predicts poor outcomes in severe burns, while prior malignancy increases sepsis risk [3]. This case highlights the importance of considering haematologic malignancy in atypical presentations and the potential value of routine peripheral blood smear screening in patients with persistent cytopenias. Derangements in blood counts should be investigated broadly, without the assumption of infection as the sole cause, as prompt diagnosis and treatment of conditions like APL can substantially improve clinical outcomes, even in critically ill patients.