Case Report of Acute lymphoblastic leukemia in young children

CLINICAL CASE REPORT - Acute lymphoblastic leukemia in young children                                        

       Compiled by – Dr. Poonam Lalla

Case history

The patient, a 2-year-old baby girl visited the Hemato-oncology OPD of a tertiary care children’s hospital in Southern India. The patient was a known case of B-Cell Acute Lymphoblastic Leukaemia and had come for her chemotherapy.

The blood sample was run on Erba H560 - a fully a                   utomated 5-part Differential Hematology Analyzer.

About the disease

Acute lymphoblastic leukaemia sometimes called Acute Lymphocytic Leukaemia, is the most common form of leukaemia found in children, accounting for about 30 percent of all paediatric cancers. Acute lymphoblastic leukaemia affects the immature forms of white blood cells, called lymphocytes. There are two basic types of lymphocytes, B-lymphocytes and T-lymphocytes, and their immature forms are the source of the two corresponding subsets of ALL, T-ALL and B- or pre-B ALL. The lymphoblasts overproduce and crowd out normal blood-forming cells in the bone marrow.

It affects certain cells in the immune system, called B cells and T cells. The disease starts in the child's bone marrow, which is the spongy centre of the bones where new blood cells grow. The leukaemia cells grow very fast and crowd the bone marrow, so the bone marrow has trouble making enough normal cells. The patient is given chemotherapy to treat the disease. Some children may need a stem cell transplant, too.

Causes

• Most of the time, the cause is unknown

• Certain factors influence the occurrence like exposure to high doses of X-rays and other forms of radiation, or cancer treatment with chemotherapy.

• Children with certain genetic diseases, such as Down syndrome, are also more likely to get acute lymphoblastic leukaemia.

              Symptoms

The symptoms start when leukaemia cells crowd out normal blood cells in the bone marrow. The types of symptoms the child has will depend on the number of cancer cells and healthy blood cells. Children with B-cell acute lymphoblastic leukaemia may exhibit symptoms like bleeding or bruising more easily than usual, feeling very tired, getting infections more often, and loss of appetite. A few other symptoms include bone or joint pain, limping, fever, pale skin, red or purple spots or petechial spots on the skin, and swollen lymph nodes in the neck, underarms, or groin.

Diagnosis

• Blood tests to check the number of blood cells, especially for sick white blood cells

• A bone marrow test is also required. Samples of the bone marrow, usually from the leg or spine are taken.

Smear under Microscope

Information from Erba H560 (Fully Automated 5 part differential hematology analyzer)

Scattergram on Erba H560 – Fully Automated 5 part Di­ Hematology Analyzer

Interpretation

Scattergrams can be used as screening aid in differentiating various reactive and neoplastic conditions. The pattern analysis of already diagnosed cases of various acute and chronic leukaemias confirms the fact that all of these cases do have an individualized plot pattern. The plot patterns can be used for the proper triaging of cases for further molecular and cytogenetic evaluation. These patterns with a definitive morphological assessment of peripheral blood and bone marrow examination also can be used in monitoring cases on therapy.

The report obtained on Erba H560 suggests -

• Very low White Blood cells of 2.67 which are also reflected in the scattergram as low population.

• Abnormally high count of 77% of Lymphocytes which is shown in green colour and Atypical cells are seen in the scatter between Lymphocytes and Monocytes which is 6%

• Abnormal PDW –platelet distribution width which can be seen in the scattergram as a wide graph.

To know more about Erba H560- 5 Part Diff Hematology analyzer click on: https://transasia.co.in/instrument/hematology/h-560-r/76