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DC : Differential count
- Neutropenia (low neutrophil)
- divide until blast stage and arrest : mature cell suppressed
- lask of functional WBC -> fever
- metabolic changes -> fever

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Blast cell
- Scanty to moderate cytoplasm
- No granules
- No nucleoli in nucleus

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1. pathogenesis of acute leukemia
2. Interpret lab investigation

additional investigation to confirm diagnosis :
- bone marrow biopsy
- bone marrow aspirin
- flow cytometry

3. Types of acute leukemia :
- acute lymphoblastic leukemia (ALL)
- acute myeloid leukemia

4. Pathophysiology of signs and symptoms
- symptoms resulting from bone marrow failure or organ infiltration with leukemic cells

5. MERCI

6. Treatment :
- chemotherapy - eradicate blast cell
- blood product (pack cell and platelet transfusion)
- stem cell transplant

7. Differential diagnosis
- at least 5

8. Other signs and symptoms to be elicited of acute leukemia
- cardiac murmur

# each person has not more than 10 minutes
# 5 min - QnA

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1. TWBC : high -> leukocytosis

2. Hb : low -> anaemia

3. Platelet : low -> thrombocytopenia

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1. Lymph nodes enlarged
- increase proliferation WBC
- fever infection
- infiltration of blast cells

2. Spleenomegaly
(same)
3. Hepatomegaly
(same)

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- low platelet
- spontaneous bleed

Bruises : mucocutaneous bleed
- leaking of small capillaries

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- indicate anaemia
- low Hb

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other hx to elicit :
respiratory distress
chest pain
cough
SOB
lower respiratory tract
sore throat
dysuria
bloody urine - hemeturia (glomerularnephritis)
vaccination - normally spontaneous onset and not prolonged (in this case is not parallel since pt is having hepatomegaly & spleenomegaly)

Must determine source of fever :
1. Upper or Lower respiratory tract
2. Acute Rhemautic Disease
3. UTI

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- thrombocytopenia
- trauma (brushing too hard)
- vitamin K deficiency
- infection
- leukemia

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Infection :
- viral infection (EBV, HIV, acute viral hepatitis, cytomegalovirus (CMV))
--> prolonged fever & splenomegaly

Gum bleeding:
Thrombocytopenia (lack of platelet)
Leukemia (hematological malignancy)
Lymphoma - can be found in children

*Iron Deficiency Anaemia o

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Fever of 3 weeks
spontaneous gum bleeding

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Ryan
8-year old boy

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Trigger Part A Ryan, a 8-year-old boy presented with history of fever for 3 weeks associated with spontaneous gum bleeding. On examination, he was pale and febrile. Multiple bruises were noted over the upper and lower limbs. There were generalized lymph nodes palpable. The liver was palpable 3 cm below right costal margin and spleen size of 4 cm below left costal margin.