PBL 3 Session 1 (Group 6) by VIGNES A/P RAMAN Moe

trigger 1

25nadzimahjaafar03 — 2024-02-07 06:31:00 UTC

gingival- bleeding of gums

easy fatiguability-Has the tendency to get tired easily

trigger 1

25nadzimahjaafar03 — 2024-02-07 06:32:28 UTC

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

Trigger 1

m2182483 — 2024-02-07 06:32:45 UTC

trigger 1

25nadzimahjaafar03 — 2024-02-07 06:47:23 UTC

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

physical examination= palpation for organomegally
PT and APTT= check coagulating factor deficiency

Trigger 2

m2182483 — 2024-02-07 07:02:36 UTC

trigger 2

25nadzimahjaafar03 — 2024-02-07 07:05:51 UTC

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

trigger 2

25nadzimahjaafar03 — 2024-02-07 07:30:55 UTC

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

trigger 2

25nadzimahjaafar03 — 2024-02-07 07:35:40 UTC

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

physical examination= palpation for organomegally
PT and APTT= check coagulating factor deficiency

Trigger 3

m2182483 — 2024-02-07 07:41:23 UTC

trigger 3

25nadzimahjaafar03 — 2024-02-07 07:47:25 UTC

chromosomal translocation - chrm breaks and reattach to diff chrm
flow cytometry - use to detect and analyse chemical and physical chracteristic of cell, counting
immunophenotyping- tech that uses ab to identify cell based on their type of ag
FISH- tech detect abnormalities in chrm
complete remission- all symptoms and sign of disease have dissappeared

trigger 3

25nadzimahjaafar03 — 2024-02-07 07:47:48 UTC

chromosomal translocation t(15,17)- cause of APML, block differentiation of WBC hnce we see mononuclear cell
immunophenotyping- diagnose disease associated with types of Ag and Ab
FISH- observed specific dna sequence
patient was diagnosed with acute promyelocytic leukaemia (APL)
prompt treatment of the DIC-related bleeding with blood component
therapy was initiated and led to normalisation of the blood coagulation tests
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.

trigger 3

25nadzimahjaafar03 — 2024-02-07 08:00:44 UTC

Final diagnosis:

patient had Acute Promyelocytic Leukemia (APL)