1 / 30

CASE REPORT hematology

CASE REPORT hematology. Monika Csóka MD, PhD. 16 year old boy no abnormalities in previous anamnesis 2 weeks before viral infection (fever, coughing) 1 day before petechias , bruises, hematomas on skin and oral mucosal membranes he was presented in hematology outpatient dept. ?.

franciscolowe
Download Presentation

CASE REPORT hematology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE REPORThematology Monika Csóka MD, PhD

  2. 16 year old boy • no abnormalities in previous anamnesis • 2 weeks before viral infection (fever, coughing) • 1 day before petechias, bruises, hematomas on skin and oral mucosal membranes • he was presented in hematology outpatient dept.

  3. ? • Trombocytopenia, thrombocytopathia • Vasculopathia • leukemia Clinical data Laboratory values

  4. Clinical data • Lymphnodes • Liver • Spleen • Testes • Leukemic infiltration in skin, gingiva • Neurological signs

  5. Lab. • Blood count • LDH • Peripheral blood smear

  6. lab • LDH 1600 U/l • CRP 34 mg/l • GPT 29 U/l • GGT 71 U/l • Kreatinin 110 umol/l • Uric acid 202 umol/l • Smear: thrombocytopenia, no other abnormalities

  7. ITP ? • Bone marrow aspiration not obligatory • But obligatory if corticosteroid treatment is planned • First line treatment: IVIG or corticosteroid (effectivity, side effects, price)

  8. Next step • 16 years • 70 kg • Planned treatment: corticosteroid • Diagnostics: bone marrow aspiration

  9. Surprise!!! • Bone marrow smear: 70% lymphoblast • CD10+, CD19+, CD20+ • Dg: ALL

  10. ALL • Most common malignancy (33%) • ALL 75% • AML 20% • CML (CLL) 5%

  11. Clinical signs • Fever • Anaemia • Bleeding • Lymphadenopathia • Hepatosplenomegalia • Bone pain

  12. Diagnosis • Blood count, smear, lab • Bone marrow • LP

  13. Lab • Anemia • Thrombocytopenia • WBC (  ) • Blasts in peripheral blood smear • LDH  • Uric acid

  14. Survival • EFS 5 years 78,6% • SR 96,1% • MR 77,9% • HR 40,8%

  15. Thrombocytopenia • Thrombocytopenia is defined as a platelet count of < 150,000/ μL • Due to: • Increased destruction • Sequestration • Decreased production

  16. Thrombocytopenia • Systematic approach to evaluating patients: • History (associated illness, drugs, specific symptoms) • Physical exam (anomalies, hepatosplenomegaly, infection, tumor, lymphadenopathy, bleeding) • Careful interpretation of the complete blood count and examination of peripheral blood smear • If diagnosis not made or corticosteroid is planned consider bone marrow examination

  17. Case 2

  18. Case 2 • 14 year old female presented with complaints of: • Easy bruising x 1 month • Heavy menses • 1-2 episodes of fever in the past month • 2 days of cervical lymphadenopathy (resolved) • Occasional night sweats • No weight loss

  19. Case 2 • Initial laboratory findings: • WBC: 3.15 x 1000/μL (4.5 – 11.0) • RBC: 3.26 M/μL (4.6 – 6.2) • Plt: 3.16 x 1000/μL (150 – 400) • Hgb: 8.80 g/dL (14.5 – 18.1) • Hct: 26.7% (42 – 54) • MCV: 81.8 fL (80 – 100) • MCH: 27.0 pg (28 – 34) • RDW: 16.1% (11.5 – 14.5) • Abs Neutrophil: 1.63 x 1000/μL (1.8 – 7.8)

  20. Case 2 • Differential diagnosis of pancytopenia with severe thrombocytopenia: • Marrow infiltrative process (leukemia, aplastic anaemia) • Immune Thrombocytopenic Purpura (ITP) • Why the neutropenia and anemia? • Next step, bone marrow biopsy.

  21. Case 2 Diagnosis: • ITP • Iron deficiency anemia, secondary to menometrorrhagia from low platelets • Benign neutropenia

  22. Case 2 • Patient received steroids, IVIG x1 • 1 week following, repeat CBC with a platelet count of 35

  23. ITP Epidemiology of ITP: • Onset typically children 2-4 years

  24. ITP • Differential diagnosis: • Diagnosis of exclusion, need to exclude drug-induced thrombocytopenia • Familial thrombocytopenia • Check family history of low platelets unresponsive to treatment for ITP • Thrombotic thrombocytopenic purpura (TTP) • Spurious thrombocytopenia resulting from platelet clumping • Always look at the peripheral smear of a patient with thrombocytopenia

  25. ITP • Mechanism: • Patients platelets are coated with IgG antibodies. Tissue macrophages recognize the Fc receptor, and phagocytose. • May also have reduced megakaryocyte production.

  26. ITP Diagnosis: • Diagnosis of exclusion • Should exclude other causes of thrombocytopenia • Review the peripheral smear • Bone marrow examination if atypical, if corticosteroid treatment is planned • Detection of anti-platelet antibodies(49-66% sensitive (not obligatory)

  27. ITP Treatment: • IVIG • Steroids • Azathioprin (Imuran) • Splenectomy if refractory to treatment • TPO mimetics (p.o., s.c.) • Anti-D (????)

  28. ITP Goal of treatment AVOID LIFE THREATENING BLEEDING

  29. The End

More Related