Tackling the Problem of APL Leukemia

As a hospital-based hematologist, I specialize in identifying patients who have blood cancers. The most important one to find is acute promyelocytic leukemia (APL). This occurs in about 1,000 people each year in the United States, mostly young people.

The most common signs of APL are gum bleeding, nosebleeds, or new-onset heavy menstrual bleeding. Blood testing shows both low platelet count and low fibrinogen.

APL poses a conundrum because without treatment it may lead to fatal bleeding. On the other hand, treating APL leukemia almost always leads to curing it. The key is to identify it quickly and start treatment right away.

As many as 200 people succumb to APL each year in the United States, even though it is so easy to cure after it is identified. Several years ago, I realized that these “missed” APL patients are mostly in smaller hospitals and rural hospitals, where there are no hematologists available to catch them.

To tackle this problem, I began offering telemedicine hematology consults to all hospitals who need a hematologist. Our practice covers rural hospitals in several states. The service, described in ASH Clinical News (December 2021) brings much-needed hematology experts to rural hospitals. Shortly after starting this service, we met APL patient Jim Corbin from Riverdale, GA. We stabilized him and transferred him to another hospital, where he received curative treatment.Every hospital should have an inpatient hematology specialist available to identify and manage possible APL leukemia cases.

Heme Onc Call, the country’s first telemedicine-based hematology practice, was created to reform the way hematology is practiced. We provide inpatient telemedicine hematology consults, with the goal of identifying and treating patients with life-threatening blood conditions who are in the hospital.


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