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gingival- bleeding of gums

easy fatiguability-Has the tendency to get tired easily

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20 year old male= has stronger immune system compared to infants or old people and women, susceptible to get X linked disease

fatiguability, headaches- aneamia , caused by lack of transport of oxygen

gingival bleeding of one day duration/episodes of nose bleed- indicates that the person has impaired blood clotting function , nose bleeding caused by physical injury , gingival bleeding build of plaque at the gum line which can cause bacterial infection

no significant past medical or surgical history- not taking any immunosuppressant immune system still functioning well

He neither smokes nor drinks alcohol-not prone to get cancer , not exposed to carcinogens, liver and lungs are in good condition

Family and social history were unremarkable - no inherited disease/ leave in healthy environment

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anaemia= excessive bleeding from the gums and nose , headache

thalassemia= X linked disease

haemophilia= X linked disease, deficiency in the absence of coagulant factor

leukemia= early signs (nose bleeding)

Vitamin C deficiency= gingival bleeding

coagulating factor deficiency

ASSOCIATED QUESTIONS

1. vital signs= temperature, pulse rate, respiratory rate , bp

2. systemic review= check enlargement or organ

3. Full blood picture, full blood count , bone marrow aspiration

4. physical examination= palpation for organomegally

5. PT and APTT= check coagulating factor deficiency

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multiple ecchymotic skin lesion - bruises blue black on skin sign of continous bleeding

thrombocytopenia - decrease in absolute plt count

aeur rods - elliptical/straight inclusion in myeblast formed by fusion of granules

faggot cell - blast cells with multiple aeur rods in cytoplasm

d-dimer - fibrin degradation product

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ecchymotic skin lesion - problems in proliferation of WBC causing skin to appear blue

no evidence of regional lymphadenopathy - no swelling of lymph node

lung clear and no organomegaly - lungs is no affected by infection - no enlargement of any organ in abdominal region

presence of mononuclear showuin auer rods in cytoplasm with few faggot

cell - distinct feature for AML, normally polyclonal antibodies, in this case very high, might indicates neoplasm

bp - low BP, hypertension inadequate blood supply to tissue, leading to symptoms like fatigue and headache

abnormal blood coagulation tests accompanied by progressive

thrombocytopenia, decreasing fibrinogen, and elevated D-Dimer

levels, the patient was diagnosed as having laboratory evidence

of disseminated intravascular coagulation (DIC) - plt decreasing, caused by malignancy ( leukemia)and will cause heavy bleeding, DIC support diagnosis of AML - decrease in PLT can be due to DIC - prolonged PT and APTT

fibrinogen decrease - primary haemostasis - no blood coagulation

elevated D-dimer - byproduct of fibrin degradation, rapid fibrin degradation

lab result;

MCV MCH MCHC - normochromic normocytic anaemia

RDW - no abnormalities in quality of RBC

HB, HCT - 79 - mild anaemia

WBC - low neutrophil high abnormal mononuclear cell = impaired proliferation of WBC

C-reactive protein high - inflammation present

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anaemia= excessive bleeding from the gums and nose , headache

thalassemia= X linked disease

haemophilia= X linked disease, deficiency in the absence of coagulant factor

leukemia= early signs (nose bleeding) AML

Vitamin C deficiency= gingival bleeding

coagulating factor deficiency DIC

ASSOCIATED QUESTIONS

1. vital signs= temperature, pulse rate, respiratory rate , bp

2. systemic review= check enlargement or organ

3. Full blood picture, full blood count , bone marrow aspiration

4. physical examination= palpation for organomegally

5. PT and APTT= check coagulating factor deficiency

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1. chromosomal translocation - chrm breaks and reattach to diff chrm

2. flow cytometry - use to detect and analyse chemical and physical chracteristic of cell, counting

3. immunophenotyping- tech that uses ab to identify cell based on their type of ag

4. FISH- tech detect abnormalities in chrm

5. complete remission- all symptoms and sign of disease have dissappeared

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1. chromosomal translocation t(15,17)- cause of APML, block differentiation of WBC hnce we see mononuclear cell

2. immunophenotyping- diagnose disease associated with types of Ag and Ab

3. FISH- observed specific dna sequence

4. patient was diagnosed with acute promyelocytic leukaemia (APL)

5. prompt treatment of the DIC-related bleeding with blood component

therapy was initiated and led to normalisation of the blood coagulation tests

6. Treatment with specific combination chemotherapy (all trans-retinoic acid (ATRA), idarubicin, and arsenic trioxide) along with supportive care were started. He achieved complete remission and had a favorable response- patient was given treatment for DIC and chemotherapy for APL.

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Final diagnosis:

patient had Acute Promyelocytic Leukemia (APL)