Virtual Slide: A 5 year-old girl comes for a pre-school physical exam.

This 5 year-old girl comes for a pre-school physical exam. Her mother indicates she has been listless, complains of headaches, arm and leg pains. Physical exam reveals a well developed, well nourished pale child. There is slight plenomegaly and hepatomegaly with generalized enlarged lymph nodes. Scattered petechiae are seen on the legs. WBC 18 X 103   RBC   2.76 Tdt = positive        Percent    Abs   HGB   6.6 CD10 (Calla) = positive NE     6.2        1.08   HCT    19.1   LY     90.5      16.2   MCV    84.4   MO     2.8       0.5   MCH    29.9   EO      0.5       0.1   MCHC  35.5 Reference values? BA        0         0   RDW    17   Immature lymphs   PLT   26 X 103       MPV   7.4

Click the green box in the smear above to see the slide using the virtual microscope. Describe what you see and then answer the following questions. What features of the lymphocytes suggest they are malignant? What clinical features of this girl suggest this is a leukemia? How do we distinguish ALL form AML? What will the bone marrow show? Would expect the cells to be positive for PH1 chromosome? What treatments exist for this condition? Why should one be cautious of uric acid levels during treatment? Prognostic indicators for this disease? Next patient is a woman with a positive hemoccult test.

Lymphoblasts positive for terminal DNA transferase (Tdt).

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