O. M. is a 6-year-old child at a freestanding emergency room.Per the mother, O.M. is complaining of being tired, sleeping atnight with several naps in the day, and her appetite is decreasing.The mother reports an uneventful pregnancy and delivery; O.M. hasmet her milestones, and immunizations are up to date. Her parentsand younger brother are healthy. Paternal grandfather died ofcolorectal cancer in his 70s. She has no medical history and has nomedication. ÂÂ
All vital signs are normal except for an elevated heart rate andshe is minimally underweight.
All assessment findings are normal with the exception of:
·        Skin pale butwarm and dry
·        Bruising overthe buttocks and left flank
·        Noted oralmucous membranes with petechiae
·         Mildenlarged, cervical, submaxillary, inguinal nodes
·        Presence ofhepatosplenomegaly
Blood work:
Hemoglobin decreased
Hematocrit decreased
RBC count decreased
WBC 13,100/mm3
Neutrophils 58%
WBC differential identifies 11% are blast cells
Platelet count 30,000/mm3
PT/PTT normal
Later results:
Bone marrow aspirate: 94% blast cells, 3% erythroblasts, 3% allother cells.
Reverse Transcriptase - Polymerase Chain Reaction: positiveTEL-AMI fusion gene. No other abnormality.
Chest x-ray: Normal
Lumbar puncture: Cerebral spinal fluid normal
Immunology: positive for cytoplasmic µ heavy chain protein
- Explain the genetic implications and risk factors in thedevelopment of Acute Lymphoblastic leukemia
- Explain the pathophysiologic or physiologic response leading toO.M. being tired, sleepy, and decreased appetite.
- What other patient information would you have wanted to have aclearer understanding of the patient?
- Provide examples of chemical exposures, environmental hazards,or antigens that may lead to leukemia
- What is the prevalence of childhood ALL?