Wednesday, April 22, 2009

All the King's Horses

This is part one of a two part case.

A three year old male with Down Syndrome presents with a limp and refusal to bear weight. He says his legs hurt. An examination shows petechiae and purpura on legs. You decide to draw some labs and find that he is anemic and thrombocytopenic with normal WBCs. A Wright's stain of the bone marrow aspirate looks like this:

Challenge: What's the most likely diagnosis?

Image shown under GNU Free Documentation License.


deardoc said...

Leukemia..Acute Lymphoblastic ?

Craig Chen said...

Exactly right!
All the King's Horses

This is acute leukemia, the most common form of childhood cancer (30%) and ALL is five times more common than AML. The peak incidence is in children (M>F) 2-5 with higher risk for those with genetic and immunodeficiency syndromes. The image shows precursor B-cell acute lymphoblastic leukemia (ALL).

Sources: UpToDate; Wikipedia.