Oo, mgt: + iaren beonat «1 ae pg bet gh ae Appendix LL... a'k* ° Hospital Summary of Leukemia Case Admitted on 10-272 to National Cancer Institute, Hematology and Supportive Care Branch “The patient {s a 19-year-old man from the Marshall Islands, who transfers from the hospical of the Brookhaven National Laboratory with a tentative diagnosis of acute leukemia, PRESENT ILLNESS: ¥ it This patient hae been followed with yearly physicals and blood counts by the Medical Research Center vf the Brookhaven Nacional Laboratory since age one, at which at Poy de time he suffered an accidental radiation exposure of 175 total body rads. He had a =~ ed are oat transient leukopenia one month following exposure but since then has had normal blood counts at his yearly examinations. Ac the cime of a roucine evaluation in August 1972, his peripheral blood white count was 1,200, platelee count 119,000, and red blood cell count 4.4 million. Actempe ac a bone marrow aspiration at that time was unsuccessful, and on September 29, 1972, the patient was flown to the Brookhaven Medical Research Center far further evaluacion. He had not complained of easy fatigability, spontaneous or unusual brufsing or bleeding, joine or muscle aches, or an increased number of infec tions. At the time of admission on September 29, the hemoglobin wus 12.5, white blood cell coune 700 with 26% polys, 28% lymphocytes, and the remainder abnormal monocytic precursors, Urinalysis, liver function tests, and prothrobin time were all within normal limits. A bone marrow aspirate in the left posterior iliac crest was performed and revealed a predominance of early myeloid precursors with some dissociation of cyto- plasmic and nuclear maturation and presence of Auer rods in the cytoplasm of myeloblasts. On September 30, the patienc had an asymptomatic temperature elevation to 101°F, Physical examination then revealed slight injection of the pharynx and a chronically scar- ved left tympanic membrane. Chese x-ray was normal, Cultures were taken, and the patient was begun ac thac time on treatment with keflin and gentamicin. He was placed on isolation, On October 1, the paciene was afebrile, and arrangements were made to “Peay aif transfer him here. PAST HISTORY: | Qperarions:; Accidents: Medicines: ”FAMTCrY HISTORY: Subtotal thyroidectomy. None Occasional “Anacin™ tablet; synthroid, 0.3 mg. daily from 1968 until May 1972, Mother, father, six brothers, and three siatcrs are all living and in good health in the Marshall Islands. Clinica, BCORD Kh ier end Phguael & Rongelap (54) 09-44-40 3 O teewey Comtennes L - e THE CLINICAL CENTER NATIONAL INSTUTWTES GF PuLALTC - 140 = oO foten we CT) Contimenten HiM.OFF Bee, $PE