Question

The Case:

Maryam, age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation.

Questions:

1. What laboratory results would you anticipate due to her ecchymosis and petechia?

2. Why would it be important to inspect her gums and teeth?

3. Why is her liver enlarged?

Answer 1

Ans) 1) Petechiae are attributable to platelet or vascular abnormalities; if systemic symptoms are present and the petechiae are tender and elevated, vasculitis should be suspected. Large subcutaneous ecchymoses (bruises) without petechiae suggest coagulation factor deficiencies from liver disease or von Willebrand's disease.

2) During a check-up they examine your mouth, teeth and gums to spot any problems and their treatment can often be the first defence against gum disease. But if gum disease is left untreated at the first stage of gingivitis, it can develop into periodontitis, which is much more serious and can lead to tooth loss.

3) Infiltration of the liver by hematologic malignancies is an uncommon cause of liver failure. B-Cell chronic lymphocytic leukemia (cll) is a usually indolent disease that may infiltrate the liver, but based on a review of the literature, has never been reported to induce acute liver failure.