CHRONIC MYELOID LEUKEMIA_20241018_092422_0000.pptx

CHRONIC MYELOID LEUKEMIA_20241018_092422_0000.pptx

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  CHRONIC MYELOID LEUKEMIA CASEHISTORY Submitted to - Murzabek kyzy asel mam Presentation by : Poorva Behera Sahil Kushwah Sahu Domendra
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  55 year oldMale, Manish yadav, came in the hematological department with complaints of : • Involuntary weight loss (10 pounds over 6 months ) • fatigue • Night Sweats and low-grade fever • Pruritus (Itching over the body) • Diarrhea • Early satiety• Flushing • Marked splenomegaly • Progressive constipation • Pallor (Palms will become white)• Priapism (Painful erection) H/O present illness: • Patient was apparently normal 6 months back • She developed a swelling in the left hypochondrium that progressed to the present size She gives H/O : • Fever-low grade, intermittent, not associated with chills or rigors, for past 6 weeks • Loss of appetite • Loss of weight Past illness: • Mild hypertension (diagnosed 5 years ago). • No previous history of significant infections or blood disorders. Personal history: • Not a tobacco chewer • Not a smoker or alcoholic • No h/o chemical/ radiation exposure Family history: • No significant family history of hematologic disorders or cancers. Contact history: • No h/o contact with patients with tuberculosis Introduction Case History of CML Patients
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  • Conscious • Oriented •Afebrile • Not Dyspnoeic • Hydration Fair • Pallor+ • Pedal edema+ • Axillary, cervical, inguinal lymph nodes palpable, firm, non tender, size ranging 0.5 to 1 cm General Examination: VITALS : • Vitals • Pulse rate: 80/min • Blood pressure: 100/70 mmHg • Temperature: 98.4 F • Respiratory rate: 16/ min PHYSICAL EXAMINATION
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  • INSPECTION: PHYSICAL EXAMINATION •PALPATION: Superficial • Normothermic • No tenderness, hyperaesthesia • Direction of flow of veins - away from the umblicus • No divarication of recti • No abnormal pulsation Deep • Liver 4.5 cm below RCM, firm, smooth surface, moves with respiration, non tender • Spleen 19 cm below LCM, towards RIF, firm, non tender, smooth surface, edges well defined No other mass palpable • Shape - distended • Flanks - free • Dilated veins - upper part of abdomen • Umblicus - pushed downwards • Skin - pallor • Hernial sites - normal • A mass extending from left hypochondrium to the hypogastric region seen, it moves with respiration • PERCUSSION : • No free fluid • Upper border of liver dullness: 5th ICS • Upper border of spleenic dullness 8th ICS • AUSCULTATION : • Bowel sounds+ • No hepatic or spleenic rub • No venous hum • No bruit • PR - not done
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  • Hemoglobin (Hb%) - 6.9 g/dL (Normal: 13.8 - 17.2 g/dL) – indicating mild anemia • Total Leukocyte Count - 150,000/μL (Normal: 4,500 - 11,000/μL) • Neutrophils - 56% (Normal Range: 40-70%) • Lymphocytes - 37% (Normal Range: 20-40%) • Eosinophils - 02% (Normal Range: 01-06%) • Basophils - 01% (Normal Range: 01-02%) • Monocytes - 02% (Normal Range: 02-10%) • PCV - 19.1% (Normal Range: 38.3-48.6%) • MCV - 84.1 fL (Normal Range: 80-90 fL) • MCH - 24.7 pg (Normal Range: 27-31 pg) • MCHC - 29.3g/dl (Normal Range: 32-36 g/dl) • ESR - 102/hr • Vitamin B12 - 1000 pg/ml (Normal Range: 150-950 pg/ml) • Platelet count: - 60,000/cu.mm (Normal: 150,000 - 450,000/cu.mm) • Nap Score - 14 (Normal Range: 20-150) INVESTIGATIONS COMPLETE BLOOD COUNT
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  • RBC Normocytic hypochromic Fewcells are microcytic, hypochromic with anisopoikilocytosis Few normoblasts seen • WBC Increased Myeloblasts 16% Promyelocytes 18% Lymphocyte 26% Mature neutrophils 16% Stab form 2% Basophil 21% Eosinophil 1% • Platelets - increased • No parasites INVESTIGATIONS PERIPHERAL SMEAR
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  • Hypercellular marrow- erythroid series normal • Myeloid erythroid ratio - 17:1 • Megakaryocytes - reduced • Myeloid series increased with increase in lymphoblasts • Basophil >20% INVESTIGATIONS BONE MARROW BIOPSY
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  • Philadelphia Chromosome(t(9;22) translocation: BCR-ABL1 fusion gene detected using polymerase chain reaction (PCR). INVESTIGATIONS FLUORESCENCE IN SITU HYBRIDISATION (FISH)
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  TARGETED THERAPY (TKItoinhibittheBCR-ABL1protein Imatinib(Gleevec) 400mg daily Dosatinib 100mg daily (First line drug) × 3 months - s/e Myelosuppression, pleural & pericardial effusion, pulmonary HTN ADDITIONAL MEDICATIONS Hydroxyurea 40mg daily × 1-2 month - to reduce WBC count Allopurinol 300mg PO × 28 days - to prevent Tumor Lysis Syndrome Treatment Options SURGICAL Bone Marrow Transplantation - If resistant to TKI
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  Routine monitoring: PCRtesting for BCR-ABL1 every 3 months. Long-term follow-up: Chronic management of CML with TKIs, with regular blood tests to ensure disease control. Counseling: Provided education on CML and the importance of medication adherence to prevent disease progression. Genetic Counseling: Discussed the low hereditary risk of CML but advised regular follow-up with the hematologist. Management and Rehabilitation MONITORING CBC every 2 weeks for the first 3 months to monitor response. PCR for BCR-ABL1 every 3 months to track molecular response. Ultrasound of spleen every 6 months to monitor splenomegaly. FOLLOW-UPS
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  • Harrisons Principlesof Internal Medicine 22e - page no. 687-691 • Davidson Principles and Practice of Medicine by Stuart H. Ralston, Ian D. Penman, Mark W.J. Strachan, Richard P. Hobson • Current Medical Diagnosis and Treatment 2023 by Maxine A. Papadakis • ROBBINS Basic Pathology 10e by Kumar Abbas Aster • Medscape (https://www.medscape.com) REFERENCES
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  Thanks For Your Attencion