67/M WITH ?CML?Leukemoid Reaction

This is an online E logbook to discuss our patients' de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from the available global online community of experts intending to solve those patients clinical problems with the collective current best evidence-based inputs. This e-log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box are welcome.

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan.

                                  Case

This is the story of a 67 year old male living in a rural village of India 

A 67 year old male presented with chief complaints of fever since 2 weeks.

History with sequence of events-

The patient was apparently alright 6 months back , after which he started having fever which was of low grade, on and off, which relieved on taking medication 

currently since 2weeks patient is having high grade fever associated with chills , continuous and relieving on taking medication associated with generalised body pains.

History of constipation since 1 week .

With these complaints patient went to a local practitioner on 15/9/23 where hemogram was done and was found to have a total leucocyte count of 1,20,000 .The test was repeated the next day which again had the same results with leucocytosis and was started on tablet Hydroxyurea (in view of decreasing the leucocyte count).symptoms of patient did not subside and came to our hospital.

On Examination :

Pt is conscious coherent and cooperative 

Oriented to time ,place and persons

Vitals :

Temp-101 F

PR-110 bpm

Bp-110/70 mm hg

RR-24cpm

Spo2-96% @RA


General Examination:

Axillary and cervical lymphadenopathy +


Respiratory Examination-

Normal Vesicular Breath sounds heard

no adventitious sounds


Per abdomen Examination-

Splenomegaly +


CVS Examination-

S1,S2 heard and normal


CNS-

Nfnd

 Hemogram done at our center showed TLC of 1,11,000 cells/cumm.



Patient was suspected to have CML and was taken to a cancer institute where bone marrow biopsy and cytogeneic studies were done .








Patient was started on Tab Imatinib 400mg po od 



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 This is an online E logbook to discuss our patients' de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from the available global online community of experts intending to solve those patients clinical problems with the collective current best evidence-based inputs. This e-log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box are welcome. I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with a diagnosis and treatment plan.                              CASE  CHIEF COMPLAINTS: Patient came to the casuality with chief complaints of abdominal pain since 5 days. HOPI: Patient was apparently asymptomatic 5
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