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39 year old male patient presented with
Fever X 3 days
ANEMIC:+,LN:Multiple Lymph Node present on both side of Diaphragm
Temperature:39.2C Chest:B/L Clear
Pulse:114/min CVS:S1,S2,M+(Grade 3 SM+)
B/P:110/60mmHg P/A:Soft tender, massive Splenomegaly
MEDICAL h/o:Negative h/o DM,HTN,PTB,HEPATITIS
SURICAL h/o:Non Significant
Allergic h/o:Non Significant
Personal h/o:Alcoholic+,non smoker
WBC:6.56 X 10*9/L
Neutrophil Count:1.13 x 10*9/L,17.2%
Lymphocyte Count:14.61 x 10*9/L,70.2%
RBC:2.12 X 10*12/L,Hb:63g/L,MCV:88.2fl,HCT:18.7%
Platelets:30 x 10*9/L
? Bone Marrow Malignancy
TYPES ANC (Absolute Neutophil Count)
MILD NEUTROPENIA (1.5 – 1 X 10*9/L)
MODERATE NEUTROPENIA (1.0 – 0.5 X 10*9/L)
SEVERE NEUTROPENIA (<0.5 X 10*9/L)
Decreased Production in Bone Marrow:
cancer, particularly blood cancers
hereditary disorders (e.g. congenital neutropenia,
Vitamin B12, folate or copper deficiency
chemotherapy treatments, such as for cancer and autoimmune
Flecainide (a class 1C cardiac antiarrhythmic drug)
Trimethoprim/ sulfamethoxazole (cotrimoxazole)
AdultT cell leukemia-lymphoma: Abbreviated ATL. A
malignancy of matureT lymphocytes (T cells) with its onset in
adulthood caused by infection with the humanT-
lymphotropic virus type 1 (HTLV-1) and characterized by
circulating malignantT-lymphocytes, skin lesions,
lymphadenopathy (enlarged lymph nodes),
hepatosplenomegaly (enlarged liver and spleen),
hypercalcemia (high blood calcium), lytic ("punched out") bone
lesions, and a tendency to infection.
Recommended treatment strategy for patients with acute, lymphoma, or chronic/smoldering
ATL. MRD indicates minimal residual disease.
Bazarbachi A et al. Blood 2011;118:1736-1745
©2011 by American Society of Hematology
How to select best antibiotics for a case of
Fever with Neutropenia?
Is addition of G-CSF worthy in treatment of
Fever,Murmur,Splenomegaly is highly
suggestive of IE.Is it necessary to do
Echocardiogram & Bloood C/s?
Is this aggressive form of Acute Leukemia?
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