A 6yo boy is brought to the hospital for a 3rd episode of sore throat in 1 month. He is found
bleeding from gums and nose and has pale conjunctiva. What’s the single cell type?
a. Clumped platelets
b. Microcytes
c. Granulocyte without blast cells
d. Blast cells
e. Mature lymphocytes
Q. 1. What is the key?
Q. 2. What is the diagnosis?
Q. 3. What are the points that favour diagnosis?
Ans. 1. The key is D. Blast cells.
Ans. 2. The diagnosis is ALL
Ans. 3. Points in favour: i) Age-6yrs ii) recurrent infection (sorethroat) due to neutrpenia and abnormal lymphoblasts which cannot protect from infection iii) thrombocytopenia causing gum and nose bleeding. Iii) anaemia (pale conjunctiva) due to reduced red cell production from marrow occupation by blast cells. [Here debate came why it is not aplastic anaemia? There is no risk factor mentioned for this patient for aplastic anaemia. There may be congenital aplastic anaemia but again it would present earlier in life. So it goes more with leukaemia but it cannot be confirmed unless we do bone marrow aspiration.]