Hematology Case Study C - History: A 4-year-old male presents

MEDT 4600 Hematology Review

Case Study C

History: A 4-year-old male presents to his local pediatrician with irritability, loss of appetite and a distended abdomen. (Patient has a twin brother who is healthy and has not previous history of illness.) On physical exam the patient was febrile and irritable. The spleen was massively enlarged, liver was normal size and there was not lymphadenopathy.

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Lab results were:

WBC 298.9

RBC 3.38

HGB 11.0

HCT 33.0

MCV 85.6

MCH 30.6

MCHC 33.2

RDW 17.4

PLT 366

Retic 1.4%

LAP Score: 6

Philadelphia chromosome: Negative

Bone Marrow:

Hypercellular marrow

Peripheral Blood Smear:

All immature stages seen including bands, myelocytes, metamyelocytes,

promyelocytes, blasts. Absolute monocytosis was aboserved .

Kleihaur-Betke stain indicated that roughly 45% of RBCs contained HbF. Question 1 – What is the best diagnosis based on all the lab results? (Be specific this is a

subgroup disease.)

Patient Outcome

Patient did not respond to treatment. Patient died and four months later his brother was

diagnosed with the same disease.