Problem:

The Bruised Boy

Eight-year-old Gene is taken to his pediatrician by his father. Over the past 3 months, Gene has been overly tired, and he appears pale most days. Gene's parents have become concerned because he has lost interest in outdoor activities. His father describes him as previously active and always eager to play outside with his friends. He also mentions that Gene has been getting more bruises and nosebleeds than usual, even though he is not as active as he once was. When questioned by the pediatrician, Gene admits to having headaches and describes soreness in his joints. Physical examination reveals numerous petechiae and ecchymoses. Gene's oral temperature is 100°F. Palpation of the liver and spleen reveal no abnormalities. Gene's breathing and heart sounds are normal, as are his blood pressure and heart and respiratory rates. A blood sample is drawn for a CBC, and the results are as follows:

Hematocrit (Hct) = 36% Hemoglobin (Hb) = 8 g/dL RBC count = 2.5 x 106 /mL WBC count = 20,000/mL Neutrophil count = 7,500/mL Basophil count = 200/mL Eosinophil count = 400/mL Monocyte count = 1,800/mL Lymphocyte count = 4,700/mL Platelet count = 15,000/mL Lymphoblast count = 46% of marrow cells

These test results lead the physician to a diagnosis of acute lymphoblastic leukemia (ALL). Treatment is initiated, including chemotherapy, blood transfusion, and drugs to minimize infection. The pediatrician and the oncologist working on Gene's case tell his parents that although the prognosis is not good, Gene's chances of survival are improved because the diagnosis has been made early in the course of the disease.

Required:

Question 1: What specific findings in Gene's CBC support a diagnosis of acute lymphoblastic leukemia (ALL)?

Question 2: If a bone marrow biopsy were performed, what findings would confirm the diagnosis of ALL?

Question 3: Why is Gene's condition considered acute rather than chronic lymphoblastic leukemia?

Question 4: How would Gene's signs and symptoms differ if he had acute myeloid leukemia?

Question 5: Gene's father is concerned about the possibility of blood transfusions transmitting infectious disease such a hepatitis or AIDS. If you were the physician, how would you try to allay the father's fears?

Question 6: How has Gene's leukemia affected his erythropoiesis? Support your answer with data from his blood work.

Question 7: Sarah complains of fatigue and muscle weakness. Her sister Julie mentions that she suffered similar symptoms before being diagnosed with anemia. Julie tells Sarah that taking iron supplements corrected her anemia, so Sarah starts taking iron supplements daily. However, 6 months later, Sarah notices that her skin is becoming darker and her joints are sore. Which of the following may account for these new symptoms?

a. hemosiderosis

b. hemolytic anemia

c. thrombocytopenia

d. aplastic anemia

e. blood doping

Question 8: In adults, why is bone marrow for biopsy taken from the sternum, iliac crest, or spinous processes of the vertebrae rather than other sites?

Question 9: When chelating agents are used as anticoagulants, why is it vital that these agents bind divalent cations (ions with a 2+ charge)?

Question 10: Why do you think iron deficiency anemia is so much more common in females than in males and in pregnant women than in other women?

Could someone help to explain the answer of these questions.