PROBLEM SOLVING IN CLINICAL PRACTICE
A patient with leukaemia turns blue
Paediatric Haematology and Oncology Department, Addenbrooke’s Hospital, Cambridge, UK
Correspondence to:
Dr Matthew Murray, Paediatric Haematology and Oncology Department, Box 181, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; mjm16@cam.ac.uk
| The first 150 words of the full text of this article appear below. |
Katie, an 11-year-old, previously healthy Caucasian girl presents to her general practitioner (GP) with a 2-month history of being generally unwell with lethargy, loss of appetite, anorexia and aching legs. Past medical history reveals febrile convulsions as a young child but nothing else of note. Katie was born at term by normal delivery, is fully immunised and is on no current medication. Examination is unremarkable save for some small, shotty 1 cm diameter cervical and inguinal lymph nodes. Weight is 45 kg (75–90th centile) and height is 155 cm (90–95th centile).
The GP is concerned about a possible diagnosis of malignancy, particularly given the history. She therefore decides that further investigation is warranted and requests a full blood count (FBC).
FBC reveals haemoglobin 10.3 g/dl, white cell count (WCC) 45.5x109/l and platelets 128x109/l. Blood film reveals the presence of circulating lymphoblasts, suggestive of acute
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