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    NC - Muh Irsyad

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    Dodi Di
    The patient is a 7-year-old boy referred from another hospital with a diagnosis of hyperleukocytosis, leukemia, anemia, and thrombocytopenia. He has a history of pale skin, fever, and bleeding gums. Physical exam found pale skin, enlarged liver and lymph nodes, and low blood counts. Laboratory tests confirmed anemia, very high white blood cell count with abnormal differential, and low platelets. A peripheral smear showed increased mononuclear cells. Treatment included hydration, antibiotics, blood transfusions, and platelet transfusions. Further evaluation with bone marrow biopsy and immunophenotyping were planned.

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    NC - Muh Irsyad

    Uploaded by

    Dodi Di
    9 views18 pages
    The patient is a 7-year-old boy referred from another hospital with a diagnosis of hyperleukocytosis, leukemia, anemia, and thrombocytopenia. He has a history of pale skin, fever, and bleeding gums. Physical exam found pale skin, enlarged liver and lymph nodes, and low blood counts. Laboratory tests confirmed anemia, very high white blood cell count with abnormal differential, and low platelets. A peripheral smear showed increased mononuclear cells. Treatment included hydration, antibiotics, blood transfusions, and platelet transfusions. Further evaluation with bone marrow biopsy and immunophenotyping were planned.

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    NC_Muh Irsyad

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    The patient is a 7-year-old boy referred from another hospital with a diagnosis of hyperleukocytosis, leukemia, anemia, and thrombocytopenia. He has a history of pale skin, fever, and bleeding gums. Physical exam found pale skin, enlarged liver and lymph nodes, and low blood counts. Laboratory tests confirmed anemia, very high white blood cell count with abnormal differential, and low platelets. A peripheral smear showed increased mononuclear cells. Treatment included hydration, antibiotics, blood transfusions, and platelet transfusions. Further evaluation with bone marrow biopsy and immunophenotyping were planned.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    9 views18 pages

    NC - Muh Irsyad

    Uploaded by

    Dodi Di
    The patient is a 7-year-old boy referred from another hospital with a diagnosis of hyperleukocytosis, leukemia, anemia, and thrombocytopenia. He has a history of pale skin, fever, and bleeding gums. Physical exam found pale skin, enlarged liver and lymph nodes, and low blood counts. Laboratory tests confirmed anemia, very high white blood cell count with abnormal differential, and low platelets. A peripheral smear showed increased mononuclear cells. Treatment included hydration, antibiotics, blood transfusions, and platelet transfusions. Further evaluation with bone marrow biopsy and immunophenotyping were planned.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 18

    CLINICAL CONFERENCE

    HEMATOLOGY ONCOLOGY DIVISION


    (New Case)
    March 13th, 2023
    Dhody Setiamal/ Junior Divisi
    Randy suryawan,A. Alfia Mutmainnah, Nicholas Redly/ Madya Divisi
    Dina Fadihilah Monika,Syahrurrahman, Arwini Avissa Abdullah,Kartika Setiawaty
    / Senior Divisi
    PATIENT IDENTITY
    M.I, 7 years old (male)
    MR Number 1013042
    Date of Birth June 12th, 2015
    Admission Date March 13, 2023

    MEDICAL DIAGNOSIS

    Hiperleukositosis + Leukemia + anemia + Trombositopenia


    HISTORY TAKING
    Chief Complaint
    Pale
    History of Present Illness
    A boy 7 years old referred from syech yusuf Hospital with diagnosis
    hiperleukositosis + leukemia.
    There was fever since 1 weeks, continues fever, relieve with antipiretik, No
    seizures.
    No cough, no shortness of breath
    good appetite
    Defecation: normal, yellow
    Urination: normal, yellow
    HISTORY TAKING
    History of Past Illness
    - There was history of pale since 1 month
    - There was history of frequent fever since 3 month
    - There was history of bleeding gums 1 month ago
    - There was no history epistaxis, reddish urine and melena
    - There was history of joint pain since 2 weeks
    - History of weight loss is not noticed
    - there was no family history of malignancy.
    - No history of living near rice fields.
    - There was history of being treated 3 days at syech yusuf hospital and received
    ceftriaxone/intravenous, gentamycin/intravenous, paracetamol/intravenous,
    ambroxol/oral, packed red cell/intravena
    PHYSICAL EXAMINATION
    History of Vaccine
    Month Years
    Vaccine
    Not 0 1 2 3 4 5 6 7 8 9 12 15 18 24 3 5 6 7 8
    given
    Hep B √ √ √ √ √

    BCG √
    DPT √ √ √ √

    Hib √ √ √ √

    OPV √ √ √ √

    IPV √
    Measles √ √
    Rotavirus √

    Influenza √
    Japanese √
    Encephalitis
    PCV √
    Varicella √
    Hepatitis A √
    Tifoid √
    PHYSICAL EXAMINATION
    Vital Sign Antropomethry
    General condition: Severely illness/ Body weight : 17kg
    goodnourished/GCS 15 (E4M6V5)
    Length : 123 cm
    Blood pressure : 100/70 mmhg
    Head circumference: 55 cm ( Normal 52-57 cm)
    Heart Rate : 102 times/min
    Anthropometry:
    Temperature: 38,6°C
    BW/height: 17/23x 100 %= 73% (under nourished)
    Respiration Rate : 26 times/min
    Bw/age: 17/25X100% = 68% (severly underweight)
    SpO2 : 99 %
    Height/Age : 123/126 X 100% = 97% (Normo stature)
    Pain Scale : 0 NRS
    Head circumference: 50 cm ( Normal 49-55 cm
    BW/height: 17/23x 100 %= 73% (under
    nourished)
    Bw/age: 17/25X100% = 68% (severly
    underweight)
    Height/Age : 123/126 X 100% = 97%
    (Normo stature)
    PHYSICAL EXAMINATION
    There was pale. No icterus Lien palpable scuffner 3
    No stomatitis
    Pharynx not Hyperemesis Genitalia
    Tonsil T1-T1 not hyperemis Palpable 2 testicles inside the scrotum size
    Lymphadenopathy at submandibular dextra et 3x2x2 cm
    sinistra 1x1,5x0,5 cm
    Pulmo Extremities
    Vesicular breath sounds. Warm acral, , CRT < 3 detik
    No rhonki no wheezing.

    Manifestations of spontaneous bleeding :


    Cardiovascular
    none
    I / II heart sound, Regular rhythm
    Bleeding time (ivy metode) : 7menit
    no murmur
    Abdomen
    Peristalsis was normal,
    Hepar palpable 3 cm below costa arch
    LABORATORY FINDING
    Gowa Wahidin
    Laboratory Normal Value
    09/03/23 13/03/23

    Hb 5,4 6,8 12.0 – 16.0 gr/dL


    WBC 245.000 335.800 4.0 – 10.0/μL
    ANC 15.925 2014 >2000
    PLT 38.000 26.000 150.000 – 400.000/mm3
    MCV 82,2 84 80 -100 μm3
    MCH 35,3 26 27 - 32 Pg
    %NEUT 6,5 0,6 52 – 75 103/μL
    %LYMPH 88,8 60,8 20 – 40 103/μL
    %MONO 4,3 38,5 2 – 8 103/μL
    Ret - 0,12 0,5 – 1 /μL
    Laboratory Wahidin 13/03/23 Normal Value

    Ureum - 7 10 - 50 mg/dl

    Creatinine - 0,5 <1.3 mg/dl


    SGOT - 29 < 38 u/l
    SGPT - 14 < 41 u/l
    Albumin - 3,5 3.5 – 5.0 mg/dl
    136-145
    Natrium - 137

    Kalium - 3,8 3,5-5,1


    Clorida - 110 97-111
    LABORATORY FINDING
    Peripheral blood smear gowa hospital (11/03/2023
    Erythrocytes: Normocytic normochrome, anisitosis, ovalocytes (+), inclusion
    objects (-)
    Leukocytes: increased, mononuclear> PMN, mononuclear cells predominate
    Platelets: decreased, normal
    Impression: susp acute lymphoblastic leukemia
    Suggestion: bone marrow puntion
    Photo thorac PA RS Gowa 30/01/2023
    impression :
    Bilateral Bronchopneumonia
    ASSESMENT
    • Hiperleukositosis
    • Leukemia
    • Anemia
    • Thrombocytopenia
    TREATMENT
    - Hydration 1,5 times fluid/day with D51/4NS
    - 1)Ceftriaxon/intravenous
    - Packed red cells transfusion/intravenous ( HB 8)
    - Evaluation for tissue anoxia
    - Platelet transfusion/12hours/intravenous –
    - Evaluation for signs of spontaneous bleeding manifestations
    - Normal diet
    Planning
    - Leukemia tracking : Bone Marrow Puncture (family agrees) and
    immunophenotyping (family agrees)
    - Check calcium, magnesium, fosfat, fibrinogen
    - Routine blood checks and urine drops every day
    - Alkalinization of urine with sodium bicarbonate 1gram/m2/24jam/oral bilateral
    urine PH <6.5
    THANK YOU

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