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Chronic Myelogenous Leukemia

 

KC, a 50-years-old male attending to clinic with three-day history of swelling of his right lower leg, complain of moderate to severe pain in his right calf, and right lower leg erythematous with positive Homans sign; fatigue, 4.5kg weight loss over 1 month, anorexia and abdominal fullness. He was diagnosed 1 month ago with chronic myelogenous leukemia(CML); laboratory data included Lkcs 130×109 (130×103)

Plts 100×109 (10×103)Hgb 70(7), Hct 0.22(22%), low leukocyte alkaline phosphatase(LAP) level {40U/I}, LDH 440, uric acid 376(6); bone marrow biopsy revealed hypercellular marrow with 80% myeloid cells; cytogenetics at that time positive for translocation of t(9,22)Philadelphia chromosome, treated with hydroxurea to decrease WBC to< 20×10* followed by interferon alpha-3MU per day × 3day,then 10MU.

Past Medical History: Hypertension and GERD.

He was non alcohol or tobacco use.

                                                                                                                    Medication History:

Interferon alpha-2b, 10×106 units SC QD ( started 1month ago)

Hydrochlorothiazide 25mg PO QD

Famotidine 20mg PO BID

He was allergic to sulfa (rash)

Physical Examination:

GEN: Pale, weak-appearing man                                  VS: BP186/90, RR 22, HR100

                                                                                            T 37 C, Ht 180cm, Wt 90kg

COR: Normal S1 and S2, no murmurs

CHEST: Clear to auscultation and percussion              GU: Normal

ABD: Soft, splenomegaly,positive bowel sounds         RECT: Normal

EXT: No clubbing, cynosis, or edema

LABS:

Na 143(143)                                          Hgb 70(7)                            T Prot 68(6.8)

K 4.5(4.5)                                             Lkcs 22×109(22×103)           T bili 5.1(0.5)

Cl100(100)                                           Plts 150×109(150×103)         Glu    7.7(138)

HCO3 22(22)                                       AST 0.62(37)                        Ca  2.35(9.4)

BUN  3.9 (11)                                      ALT 0.5(30)                          PO4  1.32(4.1)

Cr 106(1.2)                                          Alk Phos 1.5(90)                   Mg 1.1(2.2)

Uric Acid 286(4.8)                              Alb 40(4.0)                            PT 11.8

LAP 40U/I                                           LDH 3.4(204)                       PTT 22.0

Hct 0.22(22%)                                                                                   INR 1.1

 

Doppler studies: Extensive thrombosis in right popliteal vein.

 

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