Predisposing factors: Patient: 2y/o, Male Familial Hx: Leukaemia and DM Paternal Grandmother

Accumulation of Immature Leukemic Cells inhibits/ suppress normal production of myeloid cells

Lymphoblastic cancer cells

Pluripotent Stem Cell

Immature Leukemic Cell proliferation

Mixed Myeloid Progenitor

Lymphoid Progenitor
Decreased Maturation of Lymphocytes

Burst Forming Unit (BFU)

Erythroid Progenitor
Red Cells

Megakaryocytic progenitor
platelets

Granulocyte/ Monocyte Progenitor

Basophil

Eosinophil Progenitor

Thymus B and T Lymphoycyte s Record of CBC result:

immature cell with morphology favoring promyelocyte 0.06 Myelocyte- 0.03 Metamyelocyte 0.01

Monocyte / Neutrophils

Eosinophi l

RAPID Accumulation of Immature Lymphoblastic Cells

Initial CBC

Dividing uncontrollably and overriding the bodys normal restrictions on cell division

Organ Infiltration

Bone Marrow Suppression

Low Production RBC, Granulocytes and agranulocytes component

RBC- 2.34 (low) Hgb 6.4 (low) Hct- 19% (low) MCV- 82 fl (borderline low) MCH- 27pg ( borderline low) MCHC- 34% ( low) RDW- 14.7 (normal) Platelet 18 ( low) WBC- 19.6 ( HIGH) Differentials: Neutrophil- 0.14 (low)

Liver, Spleen and Lymph Node Enlargement

ANEMIA

Lympho 0.86 (High)

Platelet 18( low)

Decreased hemoglobin decreasing O2 carrying capacity

Decreased blood component perfused on extremities

Decreased blood perfusion of Cerebral tissue

Decreased Prothrombin impairing coagulation

Increased WBC: Systemic Inflammatory Response due to increasing infiltration

Lower energy (ATP) producton

Pale Lips and Cheeks

Frontal Headache

Epistaxis Hematoma ( bruising on PX thigh and elbow) Skin Infiltration ( Dermal Ulcer)

Hyperthermic Response (SNS and ANS response)

Easy Fatigability Decreased appetite and activity

NDX: Impaired Peripheral Tissue Perfusion

NDX: Impaired Cerebral Tissue Perfusion NDX: Impaired Skin Integrity Ineffective Protection PC: Bleeding (Internal and External) Risk for Injury Risk for Impaired Oral Mucosa

Recurrent Febrile episodes

NDX: Activity Intolerance

NDX: Ineffective Thermoregulation: Hyperthermia

Ram Justine Trinidad

2 y/o , Male Acute Lymphocytic/ Lymphoblastic Anemia Symptoms: Easy Fatigability Pale lips and cheeks Recurrent Fever ( relieved by paracetamol) Decreased appetite and activity Frontal headache Epistaxis Big hematoma at thigh ( Easy bruising)

Paternal Grandmother ( leukemia, DM) Complete immunization Hyperbilirubinemia (1st month old)

Labs
2nd CBC- (date??) **immature cell with morphology favoring promyelocyte Myelocyte- 0.03 Metamyelocyte 0.01 0.06

( all of them suggesting abnormal accumulation of immature form of a type of white blood cell granulocyte ( myelocyte), the progenitor of lymphocytes) 1st CBC (date????) RBC- 2.34 (low) Hgb 6.4 (low) Hct- 19% (low) MCV- 82 fl (borderline low) MCH- 27pg ( borderline low) MCHC- 34% ( low) RDW- 14.7 (normal) Platelet 18 ( low) WBC- 19.6 ( HIGH) Latest CBC (date???- IMPORTANT!!!!) Hgb- 53 (low) Hct- 0.16 (low) WBC- 11.7 (low) Neutrophil- 0.14 (low) Lympho 0.86 (High) Platelet 30 ( High) PT/APPT ( DATE PLS) SIGNIFICANT!****** ARE YOU SURE WITH this LAB? Parang mali, dapat alam yung DATE, is this lab after Blood transfusion???? PT- 12 sec Control- 13.5 sec APPT- 30 sec Control 43 sec Dermal Ulcer (Probably kasi immunosuppresed siya, so greater and chance na kahit normal fauna ay magcause ng infection and even ulceration sa gastric )

pallor, lethargy and dyspnoea. Persistent fevers, infections and malaise are features of neutropenia. Thrombocytopenia gives rise to spontaneous bruising, purpura, bleeding gums and menorrhagia. Children often present with aching and tender bones due to overproductive bone marrow. Enlarged lymph nodes, spleen and liver can be features of ALL. Gum hypertrophy, skin infiltration, central nervous system involvement and testicular infiltration