Diffuse intravascular coagulation during induction chemotherapy for B-cell acute lymphoblastic leukemia

First evidence of metastasis in our patient was elevated ALP which led to further work-up and diagnosis of bone marrow metastasis.This case highlights the importance of bone specific ALP steering the recognition of isolated breast cancer micrometastases causing bicytopenia.The clinicians need to be aware of such rare presentations and association of ALP.