1. The patient, a 20-year-old woman, was admitted with fever, left leg swelling and pain, and easy fatigability. Testing showed bilateral acute leukemia with involvement of both lymphoblastic and myeloblastic cells. 2. Deep vein thrombosis is a known complication in acute leukemia, likely due to hypercoagulability, hyperleukocytosis, and effects of treatment. Management involves anticoagulation but this poses challenges in thrombocytopenic patients. 3. The patient's prognosis is poor given her diagnosis of biphenotypic acute leukemia, which is resistant to treatment and has a high risk of relapse.

1. INTERESTING CASE OF DEEP VEIN THROMBOSIS PROF.DR.K.H.NOORUL AMMEN’S UNIT M5 DR.M.ARIVUMANI

22. BMA done on 29/7/11

25. Lymphoblast & myeloblast

26. lymphoblast

27. Myeloblast

28. myeloblast

34. EGIL scoring for biphenotypic acute leukaemia. The score for each lineage is calculated and if that lineage score > 2, that lineage is present. EGIL-European group for immunological classification of leukemia POINTS T CELL LINEAGE B CELL LINEAGE MYELOID LINEAGE 2 POINTS CD 79 CD3 TCR MPO 1 POINTS cCd22 CD10 CD19 CD20 CD2 CD5 CD8 CD10 CD13 CD33 CDw65 CD117 0.5 POINTS Tdt CD24 Tdt Cd17 cd1A CD15 CD15 CD24

36. Copyright ©2009 Ferrata Storti Foundation Zheng, C. et al. Haematologica 2009;94:1778-1780 Figure 1. Treatment schedule on the BAL patients

37. When immunophenotyping is not possible steroid trial should be started

45. Wells Probability score for DVT <2 DVT unlikely, >2 DVT likely Clinical features points Active cancer 1 Paralysis,paresis,recent immobilisation of lower extremities 1 Localised tenderness along deep venous system 1 Entire leg swollen 1 Calf swelling>3cm larger than asymptomatic side 1 u/l pitting edema 1 Collateral superficial veins(non varicose) 1 Previously documented DVT 1 Alternative diagnosis as likely or more likely than DVT -2