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Consult was done at the barangay health clinic he was given anti-tussive and Paracetamol
PE:
Oriented but in CP distress
VS: BP 90/60; CR 85; RR 18
Skin: No pallor, warm to touch with good skin turgor
HEENT: pale palpebral conjunctiva, distended neck veins, CLAD, bilateral
Lung: Symmetrical chest wall expansion, clear breath sounds
Hear: normal rate with normal rhythm, no murmurs
Extremities: cold clammy extremities and capillary refill > 2 seconds
CBC
Test Result Interpretation
Hgb 99 Decreased anemia
Hct 0.30 Decreased anemia
WBC 110 x 10^9 Increased leukocytosis
Neutrophil 10 Decreased neutropenia
Lymphocyte 38 Normal
Eosinophil 0 Normal
Monocyte 2 Normal
Blasts 50 Abnormal finding
Platelet 140 x 10^9 Slightly Decreased
2. What other clinical findings or data you want to elicit from your patient to support your
clinical impression?
LRTI t/c PTB
o Duration of the cough
o Hemoptysis or coughing up of blood
o Unintentional weight loss
o Night sweats and chills
o Smoking history
Leukemia
o Enlarged liver or spleen
o Easy bruising or bleeding
o Recurrent nosebleeds
o Other infections other than what the patient recently is having
o Flow Cytometry
Flow cytometry (immunophenotyping) can be used to help distinguish AML
from acute lymphocytic leukemia (ALL) and further classify the subtype of
AML (see the table below). The immunophenotype correlates with prognosis
in some instances.
o Blood chemistry profile
Most patients with AML have an elevated lactate dehydrogenase (LDH) level
and, frequently, an elevated uric acid level. Liver function tests and blood
urea nitrogen (BUN)/creatinine tests are necessary before the initiation of
therapy. Elevation of those test results, in a patient with an elevated WBC
(>25 109/L), indicate possible tumor lysis syndrome, and treatment should
be started immediately.
o Cytochemical stains
Cytochemical stains are an important adjunct to identifying and confirming a
myelocytic leukemia. Blood cells contain various enzymes, fats, and other
substances that can be identified by cytochemical means.
o Fluorescence in situ hybridization (FISH) is a test performed on your blood or bone
marrow cells to detect chromosome changes (cytogenetic analysis) in blood cancer
cells. FISH helps identify genetic abnormalities that may not be evident with an
examination of cells under a microscope.
o Biopsy of lymph node
Check the cause of enlarged lymph nodes that do not return to normal size on
their own.
Check the cause of symptoms, such as an ongoing fever, night sweats, or
weight loss.
Check to see if a known cancer has spread to the lymph nodes. This is called
staging and is done to plan cancer treatment.
Remove cancer.
4. Do your CPC
5. What is your final diagnosis?