Reduced platelets causes tendency to bleeding
Had several episodes of epistaxis over the past
Decreased neutrophils caused tendency to infection.
Lack of Hb production due to more lymphoblast cells
production, suppresses erythropoiesis.
Thrombocytopenia causes bruises take time to heal, thus
bruises.
Lack of immune cells causes immunosuppression causes
opportunistic infection (fungi).
Treatment
Referred to paeds haematologist- starting
chemotherapy.
Parents was advised regarding chemotherapy.
Lifelong follow up required due to relapse of
disease and adverse effect of chemotherapy.
Examination
Oral X- Thrush and inflamed tonsils.
Increased temps, Heart rate, RR.
Palpable lymph nodes of the bilateral
posterior cervical axillary, inguinal.
Hepatosplenomegaly present.
CXR is normal. No mediastinal mass.
History MOA of PCM
Paracetamol has a central
month. analgesic effect that is
Symptoms Bleeding stopped once icepack placed. mediated
Bruised easily through activation of
Epistaxis since morning No cough, vomiting, diarrhea, chest, descending serotonergic
Fever for 2 weeks abdominal pain. Pain during micturition, joint, pathways. Debate exists
Sore throat pain or headache. about its primary site of
Distended abdomen No Hx of seizures. action, which may be
Pallor, No jaundice. Not attended school for 2 days. inhibition of prostaglandin
Bruise over right thigh No surgical history/dental procedures. (PG) synthesis or through
Thrush and inflamed tonsils Given Paracetamol, no drug allergies. an active metabolite
No bleeding disorders in the family. influencing cannabinoid
receptors.
Aiman Full Blood Count.
Male, 7-Year-Old. Anaemia
Abundance of blasts displaces Normochromic
other blood precursors from
Diagnosis: Pancytopenia Normocytic
marrow, inhibiting their
B-cell Acute development/differentiation Leukocytosis
Lymphoblastic Neutropenia
Leukemia Lymphocytosis
Thrombopenia
Further Investigation
Normal PT, INR, Aptt
Blast fills up the BM, spill out into the
PBF- Nucleated, Blast cells,
blood. > High N:C ratio.
Neoplastic blast continues to divide and
accumulate in lymph nodes and spleen. Bone Marrow Aspirate:
Hypercellular cell trails.
Reduced Erythropx, Megakarx,
Predominance of blast cells.
Pleomorphic, scanty cytoplasm, inconspicuous.
Immunophenotyping:
B cell progenitor.
Trephine shows hypercellular marrow.
Cytogenetic shows hyperploidy.