Leukemia help with labs/vitals

  1. 0
    I'm doing a case study where a 4-yr old girl presents with fatigue and an elevated temperature. The PCP has found that the manifestations are consistent with an upper respiratory infection, but decides to run tests to rule out leukemia.

    Her lab results are:
    Hemoglobin: 11 g/dl
    Slightly Low Hematocrit: 31%
    Erythrocyte count: 4.6 million/mm3
    LOW Platelet count: 130,000/ mm3
    LOW WBC count: 4,000 / mm3
    LOW (“segs”) Neutrophils: 1,600/ mm3
    LOW Lymphocytes: 1,200/ mm3
    Monocytes: 290/ mm3

    She has an elevated temperature of 100.4, RR of 28, BP 100/60, HR 120bpm

    I'm thinking the results are suggesting acute leukemia. However, I'm confused by why her HR is up, RR is up, temp is up, BP is low, and some of the blood counts are low. It makes sense to me that this would happen if there was an overproduction of abnormal WBC crowding out the other cells, which would then cause a decrease of RBC, thus starving them of oxygen and causing increased RR then HR. But why would it when they are decreased and the RBC is normal? I'm suppose to explain the significance, but I keep reading and researching and nothing makes sense to me. Can anyone help me understand this process?

    Thanks!
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  3. 5 Comments so far...

  4. 0
    I don't think that it is leukemia. The normal range for WBCs is 5,000 to 10,000 and the value that u have is 4,000. It would be outragously high if it was leukemia. Im not sure if values differ with peds patients. RBCs are nomal but slightly low hgb and hematocrit so dont really seem anemic. I would suspect dehydration hypotension tacycardia, with some sort of bacterial infection and the patient appears to be slightly immunocomprimised and by low neutrophils, WBCs, lymph, monocytes. Appears to be in the acute phase with a high fever. Nothing stands out not a whole lot of info to go off of.
    When you find out let me know what it is and the rationale.

    Thanks,

    Eric
  5. 0
    Its not enough info to say if it would be leukemia, However, someone can have a low WBC and leukemia in certain types. The increased HR and RR is probably due to the fever, the HR goes up as the temperature goes up as does the respiratory rate. The blood pressure is normal for a 4 year old. I hope this helped a little.
  6. 0
    It doesn't sound like leukemia. Lets hope it isn't. My 2 yr son had acute myelogenous leukemia and I know with that one and the acute lymphcytic form that the wbc is usuallly abnormally high. 100,000 and over. My son presented with fever, fatique, pallor, and wbc of 100,000 at dx and then with in an hr after he was transferred to another hospital the wbc was at 300,000. Unfortunately he ended with clots, swelling and hemorrhaging in the brain and died within 12 hrs of dx. I do know that the lab values really get messed up. The uric acid raises and platelets lower. Leukemia is an ulgy cancer. Especially the type my son had. I feel for any child and their family that has to endure being told that their child has it and then go thru the treatments. The type my son had was rare in children and very hard to treat. From what I have researched he was spared the pain and agony of treatments and life threatening complications to gain maybe another 3 to 5 yrs. It is very sad for with Bone marrow transplant the survival rate is 60%. Without it it is less. It does come down to quanity of life vs quailty.
  7. 0
    Quote from nd deb
    It doesn't sound like leukemia. Lets hope it isn't. My 2 yr son had acute myelogenous leukemia and I know with that one and the acute lymphcytic form that the wbc is usuallly abnormally high. 100,000 and over. My son presented with fever, fatique, pallor, and wbc of 100,000 at dx and then with in an hr after he was transferred to another hospital the wbc was at 300,000. Unfortunately he ended with clots, swelling and hemorrhaging in the brain and died within 12 hrs of dx. I do know that the lab values really get messed up. The uric acid raises and platelets lower. Leukemia is an ulgy cancer. Especially the type my son had. I feel for any child and their family that has to endure being told that their child has it and then go thru the treatments. The type my son had was rare in children and very hard to treat. From what I have researched he was spared the pain and agony of treatments and life threatening complications to gain maybe another 3 to 5 yrs. It is very sad for with Bone marrow transplant the survival rate is 60%. Without it it is less. It does come down to quanity of life vs quailty.

    My sincere hugs to you, having to see your little one endure this. A friend's 7 year old had leukemia for 8.5 months and I remember the roller-coaster they all rode. John just couldn't understand why HE had all the "pokes" and his siblings didn't...or why he was sick. When I did my peds rotation 11 years later I cried when we were going over Leukemia, remembering little John.
  8. 0
    My son loved to be outside. They had told us that they thought he was gonna be blind because of the hemorrhaging of his retinal vessels. Then we were told that the chemo meds were gonna make him nauseated ect... I really felt bad for the poor little guy to have to go thru all of that when he would have really wanted to be outside. He wouldn't have understood why he couldn't go out side and why he was blind. When they had weaned him off the sedative I was really worried as to how he was gonna react to being blind.


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