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

Research and Discuss the suspected diagnosis:

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

i find the Answer thanks ! for this case study

Answer 1

The Suspected Diagnosis:

The history of 4 years of child blood reports shows elevated white blood cells, low hemoglobin level, and inadequate platelets.  97% of the cells are immatured. CD19 shows surface marker antigen of B-Lymphocyte. The sign and symptoms of the child such as fatigue, weakness, multiple bruises, reveals that the patient is suffered from Acute Lymphocytic leukemia.

Etiology:

The main cause for childhood Acute Lymphocytic leukemia is malformation of DNA. The bone marrow is the place where the blood cells produce and develop. In ALL, the blood cells are not developed properly due to DNA errors and become immature cells. The red blood cells become affected and the increased WBC developed into leukemic cells.

Epidemiology:

• Every year, 5930 cases are detected in the U.S.
• Approximately 1500deaths have occurred from ALL.
• Children less than 5 years of age are at more risk than any other group.

Diagnosis:

• Complete physical examination
• CBC studies to analyze the abnormalities of red blood cells, white blood cells, and platelet count.
• Bone marrow aspiration for the microbiological examination of blood cells.
• cytogenetic analysis to detect the chromosomal abnormalities.
• Immunotyping to check the involvement of B cells and T cells.
• CSF analysis to find the leukemia cells.

Treatment:

• Treatment depends upon the type of cell involvement.
• The goal of treatment is to kill the targeted leukemic cells.
• Radiation therapy and chemotherapy to kill the leukemic cells.
• Stem cell therapy for the production of healthy cells.

Prognosis:

• Prognosis depends on the number of white blood cells, age, sex, and ethnic background.
• WBC less than 100,000cubic meter have a better prognosis.
• Translocation of chromosome such as 15 and 17, 5 and 12 have a better prognosis compared to duplication of chromosome 5.
• Prognosis also depends upon the response of cells to the treatment.