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Real Doctors (Life Makers)  |  Clinical  |  Pediatrics  |  Case discussion  |  A good question [haematology] « previous next »
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Author Topic: A good question [haematology]  (Read 9216 times)
dr_b.e.s.m
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A good question [haematology]
« on: /October/ 12, 2005, 03:36:13 PM »

A 4-year-old boy presents with severe pains in both of his legs. On physical examination, his temperature is 37.7 C (99.8 F), blood pressure is 108/68 mm Hg, pulse is 96/min, and respirations are 17/min. He is noted to have marked pallor on his lips and palpebral conjunctiva. Numerous purpura and petechiae are noted on his skin. His spleen is palpable 3 cm below his left costal margin. Laboratory evaluation reveals a white blood cell count of 1600/mm3; hemoglobin, 6.1 g/dL; and platelets, 36,000/mm3. Which of the following diagnoses is most consistent with these findings?

A. Acute lymphocytic leukemia
B. Aplastic anemia
C. Henoch-Sch?nlein purpura
D. Immune thrombocytopenic purpura
E. Thrombotic thrombocytopenic purpura
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dr_dina
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Re: A good question [haematology]
« Reply #1 on: /October/ 15, 2005, 12:49:22 PM »

i think it is ITP
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dr_b.e.s.m
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Re: A good question [haematology]
« Reply #2 on: /October/ 17, 2005, 12:22:25 AM »

I don't know the exact answer for this question to be honest, I found it in another forum and people that posted it were not sure of the exact answer.

It's a case of pancytopenia (all the three blood elements are below normal) , ITP may be show anemia in addition to thrombocytopenia but there won't be leucopenia ! Also in ITP there won't be spleenomegaly (only in chronic ITP) , there won't be bony aches.

Aplastic anemia doesn't explain the spleenomegaly and the bony aches

In HSP , there is normal platlet count , it's a vascular purpura.

TTP shows thrombocytopenia (consumption) , anemia (micro angiopathig haemolytic) , spleenomegaly. But I don't think leucopenia is found in TTP , also in TTP there are neurological and renal failure symptoms and fever is higher than this (i guess).

I think this is a case of sub leukemic leukemia , ALL. as it explains all the findings!! all what we need is a blood film and BM examination both will show the blast cells.

Again , I am not sure of this answer so please if you have any comments , post them.
« Last Edit: /October/ 17, 2005, 08:23:12 AM by dr_b.e.s.m » Logged
 
dr_b.e.s.m
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Re: A good question [haematology]
« Reply #3 on: /October/ 24, 2005, 07:10:24 PM »

We all know that leukemia is a malignancy of WBCs so we may expect that WBC count must always be elevated in leukemia. But this isn't always the case, WBCs in cases of acute leukemia are one of the following:

-Elevated in roughly 1/3 of cases (that's the classis picture that we expect)
-Normal in 1/3 of cases(called aleukemic leukemia)
-Below normal in 1/3 of cases (sub leukemic leukemia) and it's our case here.

I think this is an important concept.




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cleo_md
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Re: A good question [haematology]
« Reply #4 on: /October/ 28, 2005, 04:53:26 PM »

This is an excellent discussion Dr B.E.S.M . I am honestly impressed  Wink
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3abeer
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Re: A good question [haematology]
« Reply #5 on: /December/ 14, 2005, 07:45:10 AM »

salam

i think the answer would be A,

coz ITP TYPICALLY ORESENT IN A HEALTHY CHILD,
in aplastic anemia we dont have splenomegaly
this is not atypical HSP
& NOT TTP

regarding the low WBC count , the explanation is what dr besm wrote their  taa
ANY OTHER OPINION GUYS
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hard_way
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Re: A good question [haematology]
« Reply #6 on: /December/ 14, 2005, 12:58:07 PM »

i think Acute lymphocytic leukemia
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