mauie
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i think, aleukemic leukemia is a leukemia wherein the WBC count is low or normal. and i think, about one-third of the leukemias start with that WBC count. well, that's what i read anyway.
i also read that bone marrow is needed to establish a diagnosis because the leukocytopenic forms are difficult to differentiate from aplastic anemia, myelodysplastic syndromes and pancytopenias.
So, in aplastic anemia, there will be suppression of the trilineage stem cell, CBC will be pancytopenia, and bone marrow will be hypocellular. there will be bleeding, anemia; patient susceptible to infection.
In B12 def, there will be pancytopenia, anemia; bone marrow will show megaloblasts. there could be neurodeficits. check if patient is on a vegan diet, if he has chronic pancreatitis or ileal dse, pernicious anemia.....
in myelofibrosis, peak incidence is between 50 and 70 yrs. there will be normocytic normochromic anemia, with mild poikilocytosis, reticulocytosis, and polychromatophilia. in advanced cases, RBCs will be tear-drop shaped. bone marrow will show fibrosis. Because fibrosis may not be uniformly distributed, biopsy should be repeated at a different site in patients with suspected idiopathic myelofibrosis if the first biopsy is nondiagnostic. platelet count may be decreased, increased or normal. there will be splenomegaly.
In persons with ITP, platelets are coated with autoantibodies to platelet membrane antigens, resulting in splenic sequestration and phagocytosis by mononuclear macrophages. The resulting shortened life span of platelets in the circulation, together with incomplete compensation by increased platelet production by bone marrow megakaryocytes, results in a decreased platelet count.
typical presentation of acute ITP is abrupt onset of bruises and petechia in a healthy child. antecedent viral infection is often reported. The physical exam reveals a healthy-appearing child with widespread bruises, petechiae, and purpuric lesions involving the skin and mucous membranes. lymphadenopathy, hepatomegaly, splenomegaly, bone pain, joint pain, fever, bacterial infections, and lethargy are characteristically absent. blood count shows an isolated thrombocytopenia. the Hgb, WBC, and differential counts are characteristically normal. bone marrow exam in ITP shows an increased number of megakaryocytes and normal trilineage hematopoiesis, but this exam is not usually performed. peripheral blood smear shows thrombocytopenia with large platelets; no nucleated RBCs, immature granulocytes and circulating blasts.
this is what i know. hope this helps you.
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| mjl1717
Forum Hero
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ITP-thrombocytopenia with normal or increased megakaryocytes.
No exposure to agents. Lack of palpable spenomegaly
Aplastic anemia-hypocellular bone marrow almost total loss of
hematopoetic cells, peripheral pancytopenia.
B12- pancytopenia, hypersegmented neutrophils, megaloblastic hyper-
plasia, anti intrinsic fac. antibody, abnormal Schilling test
Myelofibrosis-fibrous tissue replaces hematopoetic cells,tear drop
erythrocytes, granulocytic precursor cells in variable #s, blasts
aleukemia leukemia-some present with pancytopenia without blasts
but consider young adults/kids and blasts greater then 30%
*Aplastic anemia and Myelodysplastic syndromes remain a clinical challenge
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| bm
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thanks for the response everyone  which of the above do you think is most appropriate for a child with dec hgb dec hct, fever, easy bruising and fatiguability?
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| mauie
Forum Newbie
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i would go for aplastic anemia...... but then, i may be wrong.....
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| carmenburana
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[quote]a child with dec hgb dec hct, fever, easy bruising and fatiguability?
I agree with you, Mauie, in that the aplastic anemia diagnosis is most prob bc you have dec everthing and as you said, myelofibrosis is more common in older folks and tends to present with marked splenomegaly.
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| mauie
Forum Newbie
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thank you, carmenburana.
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