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MEDICAL REPORT
Patient is a 22 years old female whom after hyper menorrhea which had started at 30/09/2002, referred to her doctor. About two weeks before this referral, she had contracted Ecchymosed around her feet and later, Purpura & Petechiae appeared around the eyes and on different parts of her body too. CBC test carried out on 01/10/2002 showed the following results;
PLT = 10,000 WBC = 5,500 STAB CELL=1% POLYLYMPHOCY = 7% PROMYLOCYTE = 2% MYLOCYTE = 4% HCT= 32.7 PT= 18.5 HG = 11.8 RBC = 3.78 * 106
Suspecting Leukemia, B.M. Aspiration was carried out on 03/10/2002 and during Pathologic and Cytogenic evaluations, AML-M3V was diagnosed ( full report attached ) which led to her immediate hospitalization. During her initial medical investigations no Splenomegaly, Hepatomegaly or Lymphadenopathy were observed. On 03/10/2002, she is treated with FFP, Platelet Nystation, Hydrocortisone and Cotrimoxazole and she shows hyper- sensitivity to FFP. On this date, both abdominal sonography and chest X-ray are normal. On 05/10/2002, contracts Tachypnea, Tachycardia, Abdominal distension and Limb Edema and the tests results are:
WBC= 30.2 * 103 HGB = 7.1 HCT = 21 PLT = 6,000 NEUTROPHIL = 7% SGPT = 57 SGOT = 52 BLAST = 76% PROMYELOCYTE = 6% LYMPHOSYTE= 11% PT = 18 PTT = 34
As from 04/10/2002, treatment commences with Vesanoid and 2mg of Ceftizidime ( 6mg ) each 8 hours and on 06/10/2002, she shows Subcojunctival Hemorrhage for which Doxium is administered twice daily. On this date, FDP = 160 is checked and subclavian catheters is fixed on her right side.
On 07/10/2002:
NEUTROPHIL = 3% WBC = 70.3 * 103 PROMYELOCYTE = 27% BLAST = 68% PLT = 28 * 103 HGB = 9.6 HCT = 27.2
On 08/10/2002:
PML – RARa (BV) + FDP = 160 And on abdominal sonography, Ascites, Pleural Effusion is observed and pelvic sonography is normal.
On 09/10/2002:
Chest X-ray shows pleural Effusion and Minimal Pericardial Effusion in Echocardiography and in Upright Abdominal X-ray, There is No air Fluid Level. On this date:
WBC = 103.3 * 103
PLT = 40 * 103 PROMYELOCYTE = 20% MYELOCYTE = 3% LYMPH = 4% BLAST = 73%
As from this date Navoban+ Cytarabine (100mg) were administered twice a day for 7 days and Daunoblantina (20 mg) was injected 3 times a day for 3 days. As from starting of hospitalization, she constantly receives PLT, FFP, Ceftazidime, Hydrocortisone, Sporonax ( Itraconazale ) and Trans – amine.
On 10/10/2002:
She contracts Retinal Hemorrhage on the right eye and the Lab. Tests are: LYMPH = 3% WBC = 109.7 * 103
PLT= 33 * 103
BLAST = 58% PROMYELOCYTE = 35% HBS Ag = Negative
On 11/10/2002:
CT – Scan reads: Bilateral Pleural Effusion Moderate Degree with Infiltration of Right Lung Base and both Paracardia Region.
WBC = 82.4 * 103 LYMPH = 2% PROMYELOCYTE = 44% BLAST = 54% PLT = 46 * 103 And she contracts Dysphonia.
On 12/10/2002:
NEUTROPHIL = 5%
WBC= 50.4 *103 BLAST = 50% PROMYELOCYTE = 4% LYMPH = 1%
PLT= 44* 103 PTT = 33 PT = 15.3
On 13/10/2002:
Chest X-ray shows a reduction of Pleural Effusion. Neut = 6%
WBC = 25.4 * 103 BLAST = 40% PROMYELOCYTE = 50% LYMPH = 4
PLT = 57 * 103
On 14/10/2002:
She contracts Frequency + Polyuria. BLAST = 66% PROMYELOCYTE = 30% LYMPH = 4%
WBC = 13.8 * 103
PLT = 76 * 103
On 15/10/2002:
She contracts server Edema of Genitalia in the region of vulva.
PLT = 88 * 103
WBC = 7.1 * 103 FPP = 40 PROMYELOCYTE = 40 MYELOCYTE = 5% LYMPH = 5% NEUT = 2% BLAST = 48
On 16/10/2002:
As per chest X-ray, lungs have become normal. Doppler color imaging of pelvic is normal. PROMYELOCYTE = 35% Blast = 40% Neut = 10% WBC = 3.4
PLT = 52 * 103 Monocyte = 4% LYMPH = 11%
On 17/10/2002:
PLT = 44 * 103 WBC= 1.5 * 103 Injection of Neupogen is administered twice a day.
On 19/10/2002:
LYMPH = 6% NEUT = 47%
WBC = 5.1 * 103 PROMYELOCYTE=12%
MYELOCYTE = 20% METAMYELOCYTE = 6% MONO = 4% HCT = 34.9 HG = 11.3 PLT = 43 * 103 BLAST = 5% Injection of Neupogen is reduced to once a day.
On 20/10/2002:
Edema of vulva is gone. WBC = 11000
She is released from hospital. She is prescribed with: Tranexamicacid ( 250mg ) three times a day, Doxium twice daily, Uesanoid three time a day, Aciclovir (400 mg) four times a day, Predvisolone a 50 mg dose is taken into two times, Sporonax – three capsules per day And, Ciprofloxacin twice a day.
On 21/10/2002:
Injection of Neupogen is terminated.
WBC = 16.1 * 103
PLT = 39 * 103
On 29/10/2002:
PLT = 77 * 103
WBC = 2.9 * 103
Then, Vesanoid is reduced to twice daily.
On 05/11/2002:
PLT = 282 * 103 WBC = 3.0 * 103
On 09/11/2002:
B.M.Aspiration is carried out and its results are attached.
On 12/11/2002:
PLT = 353 * 103 WBC = 6.5 * 103
Test: Method: BCR – ABL RT – PCR Undetectable Rechecked with nested PCR. On 21/11/2002 Test : ML-RARa(APL-M3) Method : RT-PCR Result : Positive On 26/11/2002 WBC=8800 PLT=191000 From 30/11/2002 second chemotherapy started. Amp. Cytarabine(100 mg) SQ BD(for 7 days) Amp.Daunoblastina 60 mg daily (for 3 days) Amp.Dexamethasone 16 mg (for 5 days) Amp.Nobavon daily (for 5 days) Serum .Lipofundin 10% 500 ml daily Serum .Aminoven 5% 500 ml On 1/12/2002 WBC = 15900 PLT = 228000 On 3/12/2002 WBC=8500 PLT = 365000 On 7/12/2002 WBC =6100 PLT =180000 From this date G-CSF(30mioU BD started) On 9/12/2002 WBC=200 PLT=71000 From this date, following drugs started Cap.Ciprofloxacin 500 mg BD Tab.Aciclovir 100 mg TDS Cap.Sporonax TDS Cap.Tranexamic Acid 250 mg TDS Vesanoid BD&Prednisolone 25 mg BD continued On 11/12/2002 WBC=200 PLT=38000 On 12/12/2002 She is received 4 unit of FFP because of epistaxis &ecchymose On 13/12/2002 PLT=16000 WBC=100 On this date ,injection of 2 unit FFP On 14/12/2002 PLT=230000 WBC=800 On this date ,injection of 5 unit FFP & 2 unit whole blood On 15/12/2002 As from this date,injectionof G-CSF daily carried out On 17/12/2002 PLT=86000 WBC=42000 As from this date,all the drugs have been cancelled exeption for vesanoid&prednisolone with as the same before. On 20/12/2002 PLT=118000 WBC=41000 On 31/12/2002 PLT=338000 WBC=8500 On 7/1/2003 WBC=9900 PLT=188000 On 12/1/2003 WBC=5600 PLT= 137000 From the above date the following Protocol (treatment) has been begun. 2 pills of Vesanoid in addition of Prednizolonefort have been prescribed by weekly for a month. Methotrexat 2.5 mg 3 times a day in addition to 6 Mercaptopurine 50 mg 3 times a day for 5 days within two treatment sessions monthly. Folidar 15 mg 3 times a day for 3 days within two treatment sessions monthly. On 21/1/2003 WBC=5100 PLT=190000 On 4/2/2003 WBC=4900 PLT=170000 On 18/2/2003 WBC=3700 PLT= 190000 On 4/3/2003 WBC=4400 PLT=260000 Methotrexat - 6MP-Folidar
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Parham Memorial
The Children's Hospital Medical Center
Mofid Kids Hospital
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Tel/Fax: +98 21 2900679 +98 21 2227207 E-Mail: Info@ParhamMedical.org
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