All,neutropenia
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A 39-year-old male presented with fever for 3 days and arthralgia and backache. Examination found an ill-looking, anemic patient with lymphadenopathy and splenomegaly. Laboratory findings included severe neutropenia, anemia, thrombocytopenia, and elevated inflammatory markers. A bone marrow examination showed acute lymphoblastic leukemia (ALL) of the L2 subtype. The patient was diagnosed with febrile neutropenia secondary to ALL.
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A 17-year-old adolescent presented with easy bruising and a nosebleed. On examination, she had generalized petechiae and bruising. Blood tests found a low platelet count of 35 * 109 but normal-sized platelets. The diagnosis that best fits is immune thrombocytopenic purpura (ITP) due to the clinical presentation of bruising and low platelet count with autoimmune destruction of platelets. ITP is an acquired autoimmune disorder causing immune-mediated platelet destruction and reduced platelet production. Treatment options include corticosteroids, IVIG, anti-D immunoglobulin, rituximab, thrombopoietin receptor agonists, or splenectomy.
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All,neutropenia
- 2. 39 year old male patient presented with complains of: Fever X 3 days Arthralgia ,Backache
- 3. G/C:ILL Looking ANEMIC:+,LN:Multiple Lymph Node present on both side of Diaphragm Vitals: 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 R/R:20/min Hepatomegaly+
- 5. 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
- 7. 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
- 15. ? Bone Marrow Malignancy Multiple Myeloma Lymphoma Infective Endocarditis Tropical Infection
- 17. LITERATURE
- 18. 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)
- 19. Decreased Production in Bone Marrow: aplastic anemia arsenic poisoning cancer, particularly blood cancers certain medications hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia) radiation Vitamin B12, folate or copper deficiency
- 20. Increased Destruction: autoimmune neutropenia chemotherapy treatments, such as for cancer and autoimmune diseases Medications : Flecainide (a class 1C cardiac antiarrhythmic drug) Phenytoin Indomethacin Propylthiouracil Carbimazole Chlorpromazine Trimethoprim/ sulfamethoxazole (cotrimoxazole) Clozapine Ticlodipine
- 28. 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.
- 30. 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
- 31. How to select best antibiotics for a case of Fever with Neutropenia? Is addition of G-CSF worthy in treatment of Neutropenia? Fever,Murmur,Splenomegaly is highly suggestive of IE.Is it necessary to do Echocardiogram & Bloood C/s? Is this aggressive form of Acute Leukemia?
- 32. Charts from www.fbnotebook.com https://pedclerk.bsd.uchicago.edu/sites/pedcl erk.uchicago.edu/files/uploads/management _0.jpg Influenced from ncbi.nlm.nih.gov/,www.bloodjournal.org
- 34. THANK YOU
Editor's Notes
- Recommended treatment strategy for patients with acute, lymphoma, or chronic/smoldering ATL. MRD indicates minimal residual disease. Unpublished preliminary results.