Case Report Anak AML

8/13/2019 Case Report Anak AML

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30 cases permillion live

birth

Each year 50children

RSHAM 45childrenJan01 - Des06

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AML

RadiationExposures

Chemical

Exposures

Smoking

BloodDisorders

Congenitalsyndromes

Uncertain,unproven orcontroversialrisk factors

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M0 Undifferentiated acute myeloblastic leukemia

M1 Acute myeloblastic leukemia with minimal maturation

M2 Acute myeloblastic leukemia with maturation

M3 Acute promyelocytic leukemia (APL)

M4 SubdividedM4 Acute myelomonocytic leukemiaM4E0 Acute myerlomonocytic leukemia witheosinophilia

M5 Subdivided

M5A Acute monocytic leukemia withoutdifferentiationM5B Acute monocytic leukemia with differentiation

M6 Acute erythroid leukemia

M7 Acute megakaryoblastic leukemia 5


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P r ol i f e r

a t i on

Di f f e r e n

t i a t i on

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AMLFull Blood Count

Peripheral BloodExamination

Bone MarrowExamination

ImmunophenotypingCytogenetic Tests

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Because AML progresses so quickly,treatment needs to begin as soon as it isdiagnosed. Treatment of chemotherapy forAML can be divided into two phases:

induction therapy and post-remission therapy For some people very high doses ofchemotherapy or radiotherapy are needed tocure, or more effectively treat their AML. As a

In these cases a bone marrow or peripheralblood stem cell transplant is used.

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A risk factor is something that increases aperson's chance of getting a disease. Somerisk factors, like smoking, can be controlled.There is no way to prevent leukemia at thistime.

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The most common complication in AMLpatients is failure of the leukemia to respondto chemotherapy. Death may occur inpatients with AML as a consequence ofuncontrolled infection or hemorrhage.

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Less than 20% of the patients with arecurrence can be cured in the long term. Fiveyear overall survival generally does notexceed 60%. When a bone marrow donor is

not available, the overall survival drops to35-60%. These prognostic factors include the

cytogenetic test, the patient's age, and the

white blood cell count. Other importantfactors include pre-existing blood disordersand a history of treatment with chemotherapyand/or radiation therapy for an earlier cancer.

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MF,boy,5 TH years old

came to the Pediatrics Department ofRSHAM on 5 th June 2011 at 17.30 pm

with the main complaint wascontinuity for chemoteraphy

chemoteraphy with themedicine Vincristine,

cyclophospamide, andAdriamycine

History of medication :chemoterphy agent, bloodtransfusion (PRC washed),

desferal.

He is regular patientfrom Hemato-Oncology

Unit in RSHAM with thediagnose of Acute

Myeloblastic Leukaemiaand had started

chemoteraphy since 19 th February 2011

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Acute Myeloblastic Leukemia

Working Diagnosis

Cotrimoxazole 2x240 mg Normal Diet 1500 kcal with 40 gr protein

Therapy

Transfusion PRC 256 cc Vincristin 1,5 mg/m 2 /week Cyclophospamide 200 mg/m 2 /week Adriamycine 40 mg/m 2 /week

Planning of treatment

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Complete Blood Count Results Normal Value

Hemoglobin (Hb) 7,80 g % 11,0 14,1 g %

Erytrocyte (RBC) 3,34x10 6/mm 3 4,40 4,48 x10 6/mm 3

Leukocyte (WBC) 3,84x10 3/mm 3 4,5 13,5 x10 3/mm 3

Hematocrite 23,40 % 37 41 %

Trombocyte (PLT) 6x10 3/mm 3 150 - 450 x10 3/mm 3

MCV 70,1 fL 81 95 fL

MCH 23,4 pg 25 29 pg

MCHC 33,3 g % 29 31 g %

Liver

SGOT 15 < 38 U/L

SGPT 19 < 41 U/L

Renal

Ureum 16 mg/dL < 50 mg/dL

Creatinin 0,29 mg/dL 0,32 0,39 mg/dL

Uric Acid


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S : Pale (+), fever (-)O :

Presence status :Sensorium : Compos mentis, Body temperature :36,8 C, BW : 20 kg, BL : 103 cm.

Anemic (-), Dyspnea (-) , Icteric (-), Cyanosis (-), Oedema (-).Localized status :Head : Eye : Light reflexes (+/+), isochoric pupil, pale conjunctiva

palpebra inferior (-/-). Ear/Nose/Mouth:within normal limitNeck : Lymph node enlargement (-), jugular vein pressure : R-2

cmH 2O.Chest : Symmetric fusiformic, retraction (-)

HR : 100-110 bpm, regular, murmur (-)RR : 24-22 tpm, regular, ronchi (-)

Abdomen : Soepel, peristaltic (+) normal.Liver / Spleen : within normal limit

Extremities : Warm, Pulse : 100 bpm, regular, adequate pressure/volume,clubbing finger, extremities were pallor, BP : 100/60 mmHg.Anogenital : Male, within normal limit

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A : Acute Myeloblastic Leukemia FAB M4

P : - IVFD D5% NaCl 0,45% 20 gtt/i macro Cotrimoxazole 2 x 240 mg- Normal Diet 1500 kcal with 40 gr protein

R : - Vincristin 1,5 mg/m 2 /week 1,2 mg / IV

- Cyclophospamide 200 mg/m 2 /week160 mg /IVDoxorubicin 40 mg/m 2 /week 32 mg / IVMTX + Dexa-M + Ara-C (8 mg 20 mg 0,8mg)Miloz amp 15 mg/IT7 June 2011 Transfusion PRC 175 cc/ 12 hour

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S : Pale (-), fever (-)O :

Presence status :Sensorium : Compos mentis, Body temperature :36,9C, BW : 20 kg, BL : 103 cm.

Anemic (+), Dyspnea (-) , Icteric (-), Cyanosis (-), Oedema (-).Localized status :Head : Eye : Light reflexes (+/+), isochoric pupil, pale conjunctiva



HR : 102 bpm, regular, murmur (-)RR : 28 tpm, regular, ronchi (-)



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A : Acute Myeloblastic Leukemia FAB M4P : - IVFD D5% NaCl 0,45% 20 gtt/i macro

Cotrimoxazole 2 x 240 mg- Normal Diet 1500 kcal with 40 gr protein

R : - Vincristin 1,5 mg/m 2 /week 1,2 mg / IV- Cyclophospamide 200 mg/m 2 /week

160 mg /IVDoxorubicin 40 mg/m 2 /week 32 mg / IV

MTX + Dexa-M + Ara-C (8 mg

20 mg

0,8 mg)

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Hemoglobin (Hb) 12,72 g % 11,0 14,1 g %





MCV 74,90 fL 81 95 fL

MCH 25,70 pg 25 29 pg

MCHC 34,40 g % 29 31 g %

Renal

Ureum 16 mg/dL < 50 mg/dL

Creatinin 0,29 mg/dL 0,32 0,39 mg/dL

Uric Acid


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S : Pale (-), fever (+)O :Presence status :Sensorium : Compos mentis, Body temperature :38,3C, BW : 20 kg, BL : 103 cm.

Anemic (-), Dyspnea (-) , Icteric (-), Cyanosis (-), Oedema (-).Localized status :Head : Eye : Light reflexes (+/+), isochoric pupil, pale conjunctiva

palpebra inferior (-/-). Ear/Nose/Mouth:

within normal limitNeck : Lymph node enlargement (-), jugular vein pressure : R-2cmH 2O.

Chest : Symmetric fusiformic, retraction (-)HR : 112-136 bpm, regular, murmur (-)RR : 24-26 tpm, regular, ronchi (-)

Abdomen : Soepel, peristaltic (+) normal.Liver / Spleen : within normal limitExtremities : Warm, Pulse : 100 bpm, regular, adequate pressure/volume,clubbing finger, extremities were pallor, BP : 100/60 mmHg.Anogenital : Male, within normal limit

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A : Acute Myeloblastic Leukemia FAB M4

Induction Phase + Renal HiperfiltrationP : - Transfusion of Trombocyte 2 unit- IVFD D5% NaCl 0,45% 20 gtt/i macro- Cotrimoxazole 2 x 240 mg (three

times a week)- Ceftriaxon Injection 1 gr /12 hour

Skin test day 1

- Sanmol Syrup 3 x cth II (if fever)- Normal Diet 1500 kcal with 40 gr

protein

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S : Pale (-), fever (+), Nausea (-), epistachis (+)O :

Presence status :Sensorium : Compos mentis, Body temperature :38,5C, BW : 20 kg, BL : 103 cm.Anemic (-), Dyspnea (-) , Icteric (-), Cyanosis (-), Oedema (-).

Localized status :Head : Eye : Light reflexes (+/+), isochoric pupil, pale conjunctiva



HR : 102-110 bpm, regular, murmur (-)RR : 24-30 tpm, regular, ronchi (-)



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A : Acute Myeloblastic Leukemia FAB M4Induction Phase + Renal Hiperfiltration

P :- Transfusion of Trombocyte 2 unit 11 th June

- IVFD D5% NaCl 0,45% 20 gtt/i macro- Cotrimoxazole 2 x 240 mg (three times

a week)- Ceftriaxon Injection 1 gr / 12 hour- Sanmol Syrup 3 x cth II (if fever)

- Normal Diet 1500 kcal with 40 grprotein

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S : Pale (-), fever (+), Nausea (-), Cough (+), epistaxis (-)O :

Presence status :Sensorium : Compos mentis, Body temperature :38,5C, BW : 20 kg, BL : 103 cm.Anemic (-), Dyspnea (-) , Icteric (-), Cyanosis (-), Oedema (-).

Localized status :Head : Eye : Light reflexes (+/+), isochoric pupil, pale conjunctiva



HR : 113 bpm, regular, murmur (-)RR : 32 tpm, regular, ronchi (-)



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A : Acute Myeloblastic Leukemia FAB M4Induction Phase + Renal Hiperfiltration

P : - IVFD D5% NaCl 0,45% 20 gtt/I macro- Cotrimoxazole 2 x 240 mg (three times

a week)

- Ceftriaxon Injection 1 gr / 12 hour- Paracetamol Syrup 3xcth II (if fever)- Ambroxol pulp 3x10mg

- Normal Diet 1500 kcal with 40 grprotein

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Hemoglobin (Hb) 9,30 g % 11,0 14,1 g %





MCV 75,50 fL 81 95 fL

MCH 24,70 pg 25 29 pg

MCHC 31,80 g % 29 31 g %

ANC 417

GFR 96,5 136,9

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AML

causes an overproduction of abnormal blast cells (immaturewhite cells)

cannot produce adequate numbers of red cells, normal white

cells and platelets

This makes people with AML more susceptible to anaemia,

recurrent infections and to bruising and bleeding easily

In this

chase

the patient was admitted the main complain history of anaemia

and always get transfusion while in hospital, recurrentinfections like cough, flu, often fever and also have history ofbleeding like epistaxis.

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diagnosis of AML is made on

bone marrow aspirate andbiopsy with the presence ofgreater than 30% blasts.

Diagnose

the patient has AML becausehe has bone marrow aspirate

on 15 th February 2011 andpresence of an excessivenumber of blast cells.

In thiscase

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A child with AML

should assessed for anaemia, decreased bleeding orbruising, frequent or repeated infections

the patient was got transfusion for his anaemia andcovered his history of bleeding and also got antibiotic forhis recurrent infection. This patient should continuing his

chemotherapy but his ANC (Absolute Neutrophil Count)less than 500

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Prognosis

Prognosis of childhood acute myeloid leukemia (AML) hasimproved significantly over the past decades, from nearlyno child surviving to a present probability of cure ofapproximately 60%.

this can only be achieved using very intensivechemotherapy which results in relatively high rates oftreatment related deaths and significant late effects

In This Case the patient was not continuing his chemmotherapy

because his ANC less than 500.

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It has been reported that a case of a 5 yearsold boy diagnosed as Acute MyeloblasticLeukemia. The diagnosis was establishedbased on history talking, clinicalmanifestation, laboratory finding and bonemarrow aspiration. The treatment of thispatient are IFVD D5% NaCl 0,45%, Amikacininjection, Cotrimoxazole, Paracetamol, diet1500 ccal with 40 gr of protein andchemotherapy with the medicine (Vincristine,Cyclophosphamide, and Adriamycin).

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Documents

Case Report Anak AML