Question

CASE STUDY II:

T. J. was 4 years old when he first presented to his family doctor with a 3-week history of fatigue, weakness, and a persistent sore throat. On physical examination he had a palpable spleen but no evidence of lymphadenopathy. He appeared pale and had multiple bruises over his lower extremities. A CBC, platelet count, and differential were carried out, with the following results:

CBC
WBC	2.40 x 109/L	MCV	87.0 fL
RBC	2.41 x 109/L	MCH	29.0 pg
Hgb	7.0 g/dL	MCHC	33.3 g/dL
Hct	21.0%	Platelets	6.7 x 109/L
Differential
PMN	3%
Blasts	97%

A bone marrow examination was performed that revealed sheets of small blasts having scant cytoplasm and indistinct nucleoli. Cytochemical and cell marker studies of the bone marrow aspirate gave the following results:

Cytochemistry
Peroxidase		Negative
NSE		Negative
Immunohistochemistry
TdT		Strongly Positive
Surface Markers
CD3	Negative	CD10	100%
CD5	Negative	CD19	98%
CD7	Negative	CD20	Negative

answer question below:

Research and Discuss the suspected diagnosis:

Include etiology, epidemiology, diagnosis, treatment, and prognosis.

Answer 1

The condition T. J. is suffering from is Acute lymphocytic leukemia

According to CBC

• WBC, RBC and platelet counts are low
• Hemoglobin is also low
• These patients have more immature white blood cells called blasts.

Due to immature white blood cells, the defense mechanism against infection is weak leading to fatigue, weakness,easy bruising and sore throat persistently.

Acute lymphocytic leukemia is common in children.

Etiology:

• DNA mutations
• Exposure to radiations
• Genetic predisposition
• Previously affected by cancer
• Chemical exposure
• Some types of viral infections

Epidemiology :

• This has poor survival rate
• This has highest rates of remission
• According to national cancer institute ,USA estimated new cases in the current year is 5930, and about 1500 deaths accounted because of ALL.

Diagnosis:

• CBC , Differential count may show low RBC, WBC and platelets due to immaturity of cells. Blast (granulocyctes)may be high due to immaturity of blood cells.
• Terminal deoxynucleotidyl transferase (TdT) test - If positive , may be a diagnostic finding for leukemia
• Bone marrow examination and biopsy
• X ray,Ct scan,Ultrasound
• Lumbar puncture
• Immunophenotyping, cytogenetic and molecular tests
• Surface and cytoplasmic markers

Treatment:

• Chemotherapy( induction therapy, post-remission therapy,maintenance therapy.)
• Bone marrow transplantation
• Stem cell transplant
• Cortico steroid therapy
• Radiation

Prognosis:

Poor prognosis and there are more chances for remission even after treatment.