all,neutropenia
TRANSCRIPT
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39 year old male patient presented with complains of:
Fever X 3 days Arthralgia ,Backache
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G/C:ILL Looking
ANEMIC:+,LN:Multiple Lymph Node present on both side of Diaphragm
Vitals:Temperature:39.2C Chest:B/L Clear Pulse:114/min CVS:S1,S2,M+(Grade 3 SM+)B/P:110/60mmHg P/A:Soft tender, massive SplenomegalyR/R:20/min Hepatomegaly+
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MEDICAL h/o:Negative h/o DM,HTN,PTB,HEPATITIS
SURICAL h/o:Non Significant
Allergic h/o:Non Significant
Personal h/o:Alcoholic+,non smoker
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INVESTIGATIONS
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WBC:6.56 X 10*9/LNeutrophil Count:1.13 x 10*9/L,17.2%Lymphocyte Count:14.61 x 10*9/L,70.2%
RBC:2.12 X 10*12/L,Hb:63g/L,MCV:88.2fl,HCT:18.7%
Platelets:30 x 10*9/L
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ESR:97mm/hrCRP:93mg/LLDH:>1200U/L
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? Bone Marrow MalignancyMultiple MyelomaLymphoma Infective EndocarditisTropical Infection
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ALL:L2
Febrile Neutropenia
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LITERATURE
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TYPES ANC (Absolute Neutophil Count)
MILD NEUTROPENIA (1.5 – 1 X 10*9/L)
MODERATE NEUTROPENIA (1.0 – 0.5 X 10*9/L)
SEVERE NEUTROPENIA (<0.5 X 10*9/L)
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Decreased Production in Bone Marrow: aplastic anemia
arsenic poisoning
cancer, particularly blood cancers
certain medications
hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia)
radiation
Vitamin B12, folate or copper deficiency
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Increased Destruction: autoimmune neutropenia chemotherapy treatments, such as for cancer and autoimmune
diseases
Medications : Flecainide (a class 1C cardiac antiarrhythmic drug) Phenytoin Indomethacin Propylthiouracil Carbimazole Chlorpromazine Trimethoprim/ sulfamethoxazole (cotrimoxazole) Clozapine Ticlodipine
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Adult T cell leukemia-lymphoma: Abbreviated ATL. A malignancy of mature T lymphocytes (T cells) with its onset in adulthood caused by infection with the human T-lymphotropic virus type 1 (HTLV-1) and characterized by circulating malignant T-lymphocytes, skin lesions, lymphadenopathy (enlarged lymph nodes), hepatosplenomegaly (enlarged liver and spleen), hypercalcemia (high blood calcium), lytic ("punched out") bone
lesions, and a tendency to infection.
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Recommended treatment strategy for patients with acute, lymphoma, or chronic/smoldering
ATL. MRD indicates minimal residual disease.
Bazarbachi A et al. Blood 2011;118:1736-1745
©2011 by American Society of Hematology
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How to select best antibiotics for a case of Fever with Neutropenia?
Is addition of G-CSF worthy in treatment of Neutropenia?
Fever,Murmur,Splenomegaly is highly suggestive of IE.Is it necessary to do Echocardiogram & Bloood C/s?
Is this aggressive form of Acute Leukemia?
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Charts from www.fbnotebook.com
https://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/management_0.jpg
Influenced from ncbi.nlm.nih.gov/,www.bloodjournal.org
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THANK YOU