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A mother notices her female child (age 4) is bruising easily, sometimes without a known cause. Her child is crying a lot and complaining her ‐legs hurt.‐ She has also not been as active as usual in the past month. In the past 48 hours the child has developed a fever and seems very fatigued. Unable to break the fever, the mother takes her child to the pediatrician. 1. Based on the age of this patient and the presenting symptoms, would you predict an acute or chronic condition? 2. Why do you think the child has pain in her legs? 3. Does this align with your answer to #1? 4. Why might the child be bruising and feeling tired? The pediatrician orders a CBC. Results are as follows: RBC count = 2.1 x 1012/L Hgb = 8.1 g/dL Hct = 24% WBC count = 38 x 109/L Plt count = 49 x 109/L Smear shows low neutrophils, high lymphocytes, and 10% blasts present 5. Based on these lab findings, is this an acute or chronic condition? 6. Taking all information thus far into account, is this likely AML or ALL? 7. List the three major ALL WHO classifications. 8. Using Box 11.1, what are the two next steps needed to diagnose this patient?
Adi S.
Supreeta N.
Part 1 Olivia, a one-year old infant, is brought to the emergency room by her parents, who report her symptoms: excessive crying, irritability, sensitivity to light, unusual lethargy, and vomiting. A physician feels swollen lymph nodes in Olivia's throat and armpits. In addition, the area of the abdomen over the spleen is swollen and tender. * What do these symptoms suggest? * What tests might be ordered to try to diagnose the problem? Part 2 Olivia's swollen lymph nodes, abdomen, and spleen suggest a strong immune response to a systemic infection in progress. In addition, little Olivia is reluctant to turn her head and appears to be experiencing severe neck pain. The physician orders a complete blood count, blood culture, and lumbar puncture. The cerebrospinal fluid (CSF) obtained appears cloudy and is further evaluated by Gram stain assessment and culturing for potential bacterial pathogens. The complete blood count indicates elevated numbers of white blood cells in Olivia's bloodstream. The white blood cell increases are recorded at 28.5 K/μL (normal range: 6.0-17.5 K/μL). The neutrophil percentage was recorded as 60% (normal range: 23-45%). Glucose levels in the CSF were registered at 30 mg/100 mL (normal range: 50-80 mg/100 mL). The WBC count in the CSF was 1,163/mm³ (normal range: 5-20/mm³). * Based on these results, do you have a preliminary diagnosis? * What is a recommended treatment based on this, preliminary diagnosis?
Shaiju T.
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