C92.40 Acute promyelocytic leukemia, not having achieved remission

ICD10CM code

#### Name of the Condition
- Acute Promyelocytic Leukemia (APL), not having achieved remission.
- ICD-10 Code: C92.40

#### Summary
Acute Promyelocytic Leukemia is a subtype of acute myeloid leukemia, characterized by an abnormal increase of immature white blood cells called promyelocytes. When it has not achieved remission, it means that the disease continues to be present or that treatment has not yet resulted in a significant reduction or disappearance of these cells.

#### Causes
The main cause of Acute Promyelocytic Leukemia is a genetic mutation involving the translocation between chromosome 15 and chromosome 17, leading to the formation of the PML-RARA fusion gene.

#### Risk Factors
- Genetic predispositions or familial history of leukemia.
- Previous chemotherapy or radiation exposure.
- Certain genetic disorders, such as Down syndrome, increase the risk.

#### Symptoms
- Fatigue and weakness.
- Easy bruising or bleeding.
- Fever and infection.
- Shortness of breath.
- Bone or joint pain.

#### Diagnosis
- Blood tests revealing high levels of white blood cells and the presence of promyelocytes.
- Bone marrow biopsy to confirm the diagnosis.
- Genetic testing to identify the PML-RARA fusion gene.

#### Treatment Options
- All-Trans Retinoic Acid (ATRA) to induce differentiation of promyelocytes.
- Anthracycline-based chemotherapy to reduce leukemic cell burden.
- Arsenic trioxide, especially in relapsed cases, to induce remission.
- Possible stem cell transplantation in cases of treatment resistance.

#### Prognosis and Follow-Up
With effective treatment, a high percentage of individuals can achieve remission. Regular follow-ups are crucial to monitor for relapse or treatment complications. Continuous monitoring with blood tests and possibly bone marrow biopsies are necessary.

#### Complications
- Severe bleeding due to a low platelet count.
- Increased risk of infections due to neutropenia.
- Possible complications from chemotherapy, such as organ damage.

#### Lifestyle & Prevention
- No definitive lifestyle changes prevent APL, but maintaining a healthy diet and regular exercise may support overall health.
- Avoiding exposure to known chemical carcinogens where possible.

#### When to Seek Professional Help
Seek immediate medical attention if experiencing unexplained bruising, persistent fever, or symptoms of severe anemia or bleeding.

#### Additional Resources
- Leukemia & Lymphoma Society (www.lls.org).
- American Cancer Society (www.cancer.org).
- National Cancer Institute (www.cancer.gov).

#### Tips for Medical Coders
- Ensure coding specificity by verifying the remission status of APL, as the ICD code differs for cases in remission.
- Avoid confusion with other types of leukemia; C92.40 is specific to APL not having achieved remission.

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