City paediatric meet

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City paediatric meet

  1. 1. Dr. L.G.Aishwarya Lakshmi MD 2 nd year Prof. Dr. P. John Solomon Department of Paediatric Hematology and Oncology Government Stanley Medical College
  2. 2. HISTORY <ul><li>Anand 6 yr Male </li></ul><ul><li>Fever - 2 months </li></ul><ul><li>Oral ulcers - 2 months </li></ul><ul><li>Investigated & treated in Dharmapuri & Salem </li></ul><ul><li>No records shown </li></ul><ul><li>History unreliable </li></ul>
  3. 3. FINDINGS <ul><li>Febrile </li></ul><ul><li>Healing oral ulcers </li></ul><ul><li>No lymphadenopathy </li></ul><ul><li>No pallor </li></ul><ul><li>No purpura </li></ul><ul><li>Abd: N , CVS: N , RS: N , CNS: N </li></ul>
  4. 4. DIFFERENTIAL DIAGNOSIS <ul><li>HIV </li></ul><ul><li>Aplastic anemia </li></ul><ul><li>Leukemia </li></ul>
  5. 5. INVESTIGATIONS AT STANLEY <ul><li>Hb: 11.1g/dL </li></ul><ul><li>TC: 4400 cells/cumm </li></ul><ul><li>DC: Neutrophils-1% </li></ul><ul><li>Band forms-4% </li></ul><ul><li>Atypical lymphocytes-13% </li></ul><ul><li>Lymphocytes-82% </li></ul><ul><li>Platelets: 19000/cumm </li></ul><ul><li>Peripheral smear: thrombocytopenia, atypical lymphocytes </li></ul><ul><li>Urine- N , CXR- N , Mantoux- Neg, HIV-Neg </li></ul>
  6. 6. INVESTIGATIONS DONE IN PRIVATE HOSPITAL IN CHENNAI(BEFORE COMING TO STANLEY) <ul><li>Hb: 12.6g/dL </li></ul><ul><li>TC: 4900 cells/cumm </li></ul><ul><li>DC: Blast cells-14% </li></ul><ul><li>Polymorphs-5% </li></ul><ul><li>Lymphocytes-80% </li></ul><ul><li>Eosinophils-1% </li></ul><ul><li>platelets -30000/cumm </li></ul>
  7. 7. INVESTIGATIONS- STANLEY <ul><li>Hb: 11.1g/dL </li></ul><ul><li>TC: 4400 cells/cumm </li></ul><ul><li>DC: Neutrophils-1% </li></ul><ul><li>Band forms-4% </li></ul><ul><li>Atypical lymphocytes-13% </li></ul><ul><li>Lymphocytes-82% </li></ul><ul><li>Platelets: 19000/cumm </li></ul><ul><li>Peripheral smear: thrombocytopenia, atypical lymphocytes. </li></ul>
  8. 8. COUNTS AFTER 1 WEEK OF STEROID <ul><li>Hb: 4.6g/dL </li></ul><ul><li>Platelets: 2000/cumm </li></ul><ul><li>TC: 10500/cumm </li></ul><ul><li>DC: Blast cells - 64% </li></ul><ul><li>Lymphocytes - 36% </li></ul><ul><li>BFM protocol : day 8 blasts <1000/µl : GR </li></ul><ul><li>day 8 blasts >1000/µl : PR </li></ul>
  9. 9. HIGHLIGHTS <ul><li>Absence of typical blast cells in peripheral blood does not rule out acute leukemia. </li></ul><ul><li>Steroids should not be used in undiagnosed fever. </li></ul>
  10. 10. PANCYTOPENIA <ul><li>Splenomegaly No Splenomegaly </li></ul><ul><li>BM BM </li></ul><ul><li>Abnormal Normal Abnormal Hypocellular Acellular </li></ul><ul><li>An approach to differential diagnosis of pancytopenia </li></ul><ul><li>Ref : Philip Lanzkowsky </li></ul><ul><li>Leukemia </li></ul><ul><li>Storage diseases </li></ul><ul><li>Lymphoma </li></ul><ul><li>Hypersplenism </li></ul><ul><li>Granuloma </li></ul><ul><li>TB, Sarcoid </li></ul><ul><li>Leukemia </li></ul><ul><li>Early aplastic anemia </li></ul><ul><li>Aplastic anemia </li></ul><ul><li>Congenital acquired: </li></ul><ul><li>idiopathic </li></ul><ul><li>secondary </li></ul>
  11. 11. ATYPICAL LYMPHOCYTES <ul><li>Some of the causes: </li></ul><ul><li>Viral infections : Infectious mononucleosis, CMV, Infectious hepatitis. </li></ul><ul><li>Bacterial infections: Tuberculosis. </li></ul><ul><li>Mycoplasma pneumonia. </li></ul><ul><li>Protozoan infections: Malaria, Toxoplasmosis. </li></ul><ul><li>SLE. </li></ul><ul><li>Sarcoidosis. </li></ul><ul><li>Atypical cells may also be seen in Leukemia and lymphoma. </li></ul><ul><li>Ref: Barbara J Bain. </li></ul>
  12. 12. ATYPICAL LYMPHOCYTE
  13. 13. LYMPHOBLASTS
  14. 14. NORMAL LYMPHOCYTES
  15. 16. IMPORTANT MESSAGE <ul><li>Absence of typical blast cells in peripheral smear does not rule out acute leukemia. </li></ul><ul><li>Persistent pancytopenia : Bone Marrow Examination. </li></ul><ul><li>Undiagnosed fever - no steroids. </li></ul><ul><li>Delay in diagnosis  Morbidity & Mortality </li></ul><ul><li>Early referral. </li></ul><ul><li>Most confirmatory test immediately. </li></ul>

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