Case 17 - Acute Lymphoblastic Leukemia

Question 1

What is the DDx of ALL

Answer 1

idiopathic thrombocytopenic
purpura (ITP), aplastic anemia, mononucleosis, juvenile rheumatoid
arthritis, and leukemoid reaction

Question 2

How to confirm ALL

Answer 2

Bone marrow aspiration:
A normal marrow contains less than 5% blasts; a minimum of 25% blasts confirms the diagnosis.

Question 3

How to confirm ALL

Answer 3

Bone marrow aspiration:
A normal marrow contains less than 5% blasts; a minimum of 25% blasts confirms the diagnosis.

Question 4

Worse Prognosis indicator

Answer 4

< 1 year and > 10 years have Higher leukocyte counts, > 50,000/mm3.
mature B-cell or T-cell immunophenotypes
hypoploidy and pseudodiploidy, Translocations with a poor outcome include t(9;22) (Philadelphia chromosome) in patients with pre-B ALL, and t(4;11) seen in infants with AML.
higher number of blasts in the cerebrospinal fluid

Question 5

Live attenuated vaccine

Answer 5

Live attenuated:
Chickenpox, MMR
influenza
Rotavirus
Yellow fever

Inactivated:
dTAP
inactivated poliovirus
hepatitis A and B,
influenza
pneumococcal
meningococcal
HPV