Question

A 2-year-old boy is being seen by a hematologist. The child's symptoms include the sudden onset of high fevers, thrombocytopenia, epistaxis, gingival bleeding, petechiae, and ecchymoses after minor traumas. The physician has ordered a bone marrow aspiration to confirm the clinical diagnosis of acute lymphocytic leukemia. If the diagnosis is positive, the child will be placed immediately on intensive chemotherapy. The physician has informed the parents that treatment produces remission in 90% of children with ALL, especially those between the ages of 2 and 8

1. What pathological condition does the hematologist suspect? Look this condition up in a reference source and include a short description of it

2.List and define each of the patient's presenting symptons

3. what diagnostic test did the physician perform? Describe

4. Explain the phrase "clinical diagnosis"?

5.If the suspected diagnosis is correct, explain the treatment that will begin

6. what does the term remission mean?

Answer 1

1. What pathological condition does the hematologist suspect?

The Hematologist suspect the disease condition of Acute Lymphocytic Leukemia(ALL). It is also called as Acute Lymphoblastic leukemia is a type cancer commonly seen in children between the ages of 2 and 8. WBCs fight against foreign bodies, but in the case of leukemia WBCs multiply and turn into cancerous cells. Identical twins, radiation, exposure to chemicals, certain genetic factors such as down syndrome, Li-Fraumeni syndrome, Klinefelter syndrome, neurofibromatosis increases the risk factors of ALL.

Two types of white blood cells called lymphoid cells and myeloid cells are produced in the body. In case of ALL, lymphoid cells are produced immaturely so they do not work properly resulting in the signs and symptoms of petechiae, bruising, ecchymoses and infection. The development and stage are identified based on the type of the lymphoid cell, either the precursor cell involvement of B-cell or T-cell.

2. List and define each of the patient's presenting symptoms

Sudden onset of fever:

In ALL, the white blood cells are multiplying rapidly and in the increased count. white blood cells are immature to fight against the infection which results in fever.

Thrombocytopenia:

Thrombocytopenia is a condition where the platelets levels are below normal. platelets are produced in bone marrow. The infiltrates of leukemia cells results in decreased production of platelets.

Epistaxis:

Epistaxis refers to nosebleed. Platelets are involved in clotting factors. Due to an insufficiency of platelet count, the clotting mechanism denied result in nose bleed even after a minor injury.

Gingivitis:

Due to infiltration of gum cells as a result of leukemia, the bleeding occurs in the gum.

Petechiae:

Tiny red spots present on the skin is called petechiae. this happens due to broken of tiny capillaries and the absence of disc-shaped cells in the platelets which help in clotting.

ecchymosis:

It occurs when blood bleed from the capillaries and enter into the surrounding tissue due to absence of disc shaped cells.

3. what diagnostic test did the physician perform? Describe

Complete blood count: To know the number of blood cells.

Liver and kidney function Test: To detect the function of the organ.

Bone marrow aspiration: A small amount of bone marrow is removed and examined for abnormal cells.

Lumbar puncture: By puncturing the spine, a small amount of CSF is collected and examined for cancerous cells.

Chromosomal tests: To analyze the genetic problems.

4. Explain the phrase "clinical diagnosis"?

Clinical diagnosis is the determination of the disease condition based on the patient's complaints, signs, symptoms, and laboratory findings.

5. If the suspected diagnosis is correct, explain the treatment that will begin

Chemotherapy: Most common treatment is chemotherapy. special drugs are given intravenously to kill the cancerous cells. Sometimes combination therapy used.

Stem cell transplant: It is the replacing of bone marrow cells from the donor's cells.

Radiation therapy: Here radiation is passed to kill and stop the growth of cancer cells.

6. what does the term remission mean?

Remission is the subside of the signs and symptoms of Leukemia. The ultimate goal of treatment of any cancer is remission. That means the patient should free from cancer cells either temporarily or permanently.