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A 2.5-year-old girl presented at a primary care clinic with a 1-week history of vomiting, diarrhea and pallor. Easy bruising and petechiae on her face and trunk had been noted 2 days previously. On the day of admission, she felt warm and had been irritable, prompting her parents to bring her to the clinic. Laboratory values were as follows: WBC 105 x109/L; Hb 4.6 g/dL; HCT 0.14 L/L; platelets 23 x109/L; differential: lymphocytes 10%, blast 90%. The peroxidase stain was negative; acid phosphatase was positive in a diffuse pattern; and PAS was positive. The bone marrow aspirate was heavily infiltrated with lymphoid appearing blast. The morphology was described as consistent with L1. Immunologic marker test showed: CALLA 90%; HLA-DR 93%; and cytoplasmic immunoglobulin positive E rosette, SIg, IgM, kappa and lambda chains were less than 10%. The patient responded well to vincristine and prednisone and is in remission.
QUESTIONS The blast in this case were said to be “consistent with L1.” What does that mean? Lymphoblasts are very small & homogenous. Scanty cytoplasm (↑N/C ratio). Nucleus is round and regular in shape with inconspicuous nucleoli.
What might be causing the patient’s anemia and thrombocytopenia?
Is the child’s age consistent with the diagnosis?
On the basis of the marker studies, are the cells B, T, pre-B, pre-T or unclassified?
Sagot :
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