CASE STUDY FOR B-ACUTE

LYMPHOBLASTIC LEUKEMIA (ALL)

WITH PRESENCE OF APLASTIC ANEMIA

BACHELOR IN MEDICAL LABORATORY SCIENCE

PREPARED BY SHAKIRA BINTI HASHIM

(4154009661)
HOSPITAL TELUK INTAN
 OBJECTIVE

To describe the clinical and laboratory features of

Acute Lymphoblastic leukemia (ALL) patient
 Boy

INTRODUCTION

No known 7 years
medical old
illness
 HISTORY

Fever

Admitted for neutropenic sepsis

Hepatosplenomegaly
 PHYSICAL EXAMINATION

• axillary CHEST X-RAY

• Multiple cervical
lymph node • Patchy
consolidational
• Bilaterally inguinal
perihilar region
small lymph node
• No mediastinal
Palpable widening
Lymph node
 LAB FINDINGS

SEROLOGY

Complement assay Result Flag Normal Range

C3 Complement 2.05 G/L H 0.9-1.8

C4 Complement 0.42 G/L H 0.1-0.4

MICROBIOLOGY

Blood Culture & Sensitivity Negative

 BIOCHEMISTRY

Test Name Result Flag Reference Range

Phosphate 0.85 mmol/L L 1.29-2.26
RENAL PROFILE
Sodium 132 mmol/L L 136-146
Chloride 96 mmol/L L 101-109
Creatinine 21 umol/L L 23-68
LIVER FUNCTION TEST
Globulin 37.8 g/L H 23-35
Alkaline 314.02 u/L H 93-309
Phosphatase
CARDIAC ENZYME
Lactate 1939.0 U/L H 110-295
dehydrogenase
HEMATOLOGY

FULL BLOOD COUNT

Parameter Diagnosis of Diagnosis of Recovery Reference
AA ALL Range

Time (weeks) 0 5 48
Hemoglobin(g/dL) 8.1 6.7 11.4 11.5-13.5
Lymphocyte 2.18 5.39 0.93 1.0–3.0
(x103/uL)

Peripheral blood 0 35 0 >30

blasts (%)

Neutrophils 0.73 0.89 3.36 2.0–7.0

(103/uL)

Platelet (103/uL) 145 104 302 150-400

 FULL BLOOD PICTURE

Parameter Diagnosis of AA Diagnosis of ALL

Time (weeks) 0 5
Red Blood Cell • Normochromic normocytic • Dimorphic red cells
anemia • NRBC seen
• Anisocytosis
• NRBC present
White Blood Cell • Leukocytopenia with • Normal white cell count with
neutropenia relative lymphocytosis and
• No blast noted monocytosis
• Abnormal lymphoid noted with
some are blastoid looking and
some having vacuolation
Platelet • Adequate on fil >30/hpf Reduced platelet count <25/hpf

Interpretation Pancytopenia Persistent pancytopenia with

abnormal lymphoid cells
 BONE MARROW ASPIRATION

Parameter Explanation

Peripheral Blood Pancytopenia with some abnormal lymphoid (blastoid looking).

Cellularity Hypercellular marrow both cell traits and fragments.

Erythropoiesis Markedly suppressed.

Granulopoiesis Markly supressed.

Megakaryopoiesis Markly suppressed.

Others 82% lymphoblasts counted. Moderate to large in size, high N:C ratio with inconspicious
nucleoli. Some of the blasts exhibit vacuolation.
Differential count Neutrophils :- Lymphocytes:-
Metamyelocytes: 1% Monocytes:-
Myelocytes: 4% Eosinophilic: 12%
Blast: 82% Plasma cells : 1%

Interpretation Morphologically, this aspirate findings are suggestive of Acute Lymphoblastic

Leukemia(ALL) most probably L3(FAB classification)
BMA (MICROSCOPIC)
 BONE MARROW BIOPSY

Parameter Explanation

Macroscopy Received multiple strips of brownish tissue measuring 3-15mm

in aggregates. Entirely submitted in 1 block.
Microscopy Generally inadequate, <5 marrow spaces. Cellular area ( 10-20%)
Adequacy: are hypercellular.
Interpretation Generally suboptimal sample, however with IHC findings,
consistent with BMA findings of Acute Lymphoblastic Leukemia.
 MOLECULAR

• Positive for CD34, CD79a, Tdt, CD20, and Cd10

IHC • Negative for CD21 and MPO

• Presence of 62% blast population expressing certain

phenotypes that confirmed the findings with underlying
IPT Precursor B-Acute Lymphoblastic Leukemia cALLA positive

• 46,XY[8]
Cytogenetics
 OUTCOME

• The benefit of getting to know the flow in

clinical and laboratory findings to diagnose this
disease.
• The advantages in studying the knowledge of
interpreting each of the patient results.
 CONCLUSION

• Childhood acute lymphoblastic leukemia have

a high rate of incidence but also good
prognosis.
• However, it will be difficult for those with
genetic abnormalities to be cured.
• Thus, scientists or the medical healthcare
need to create more advance technologies to
discover more accurate treatment.