All vital signs are normal except for an elevated heart rate and she is minimally underweight.
O. M. is a 6-year-old child at a freestanding emergency room. Per the mother, O.M. is complaining of being tired, sleeping at night with several naps in the day, and her appetite is decreasing. The mother reports an uneventful pregnancy and delivery; O.M. has met her milestones, and immunizations are up to date. Her parents and younger brother are healthy. Paternal grandfather died of colorectal cancer in his 70s. She has no medical history and has no medication.
All vital signs are normal except for an elevated heart rate and she is minimally underweight.
All assessment findings are normal with the exception of:
· Skin pale but warm and dry
· Bruising over the buttocks and left flank
· Noted oral mucous membranes with petechiae
· Mild enlarged, cervical, submaxillary, inguinal nodes
· Presence of hepatosplenomegaly
Blood work:
Hemoglobin decreased
Hematocrit decreased
RBC count decreased
WBC 13,100/mm3
Neutrophils 58%
WBC differential identifies 11% are blast cells
Platelet count 30,000/mm3
PT/PTT normal
Later results:
Bone marrow aspirate: 94% blast cells, 3% erythroblasts, 3% all other cells.
Reverse Transcriptase – Polymerase Chain Reaction: positive TEL-AMI fusion gene. No other abnormality.
Chest x-ray: Normal
Lumbar puncture: Cerebral spinal fluid normal
Immunology: positive for cytoplasmic µ heavy chain protein
1. Explain why O.M. is underweight (other than decreased appetite). Use pathophysiology or physiological phenomenon to explain your answer.
2. When you read the case did you suspect acute lymphoblastic leukemia (ALL) or something else? Explain.
3.Explain the abnormality of TEL-AMI fusion gene and specify which cells are affected, T-cells or B-cells.
4 Explain why the red blood cell count, hemoglobin, and hematocrit levels are low. Use pathophysiology or physiological phenomenon to explain your answer.
5.Explain what is occurring with the white blood cell count and differential. Use pathophysiology or physiological phenomenon to explain your answer.
