- Ist -
Admitted on 10-2-72 to National Cancer Institute,
Hematology and Supportive Care Branch
Expired on 11-15-72 from National Cancer Institute,
Hematology and Supportive Care Branch
HOSPITAL COURSE:
Problem No, 1 - Acute Proganulocytic Leukemia:
On the morning of the second hospital day che patient had a posterior iliac crest
bone marrow aspirate revealing decreased normal marrow elements and infiltration by
cells with prominent eosinophilic cytoplasmic granules and prominent nucleoli. Some
of these cells had Auer rods in the cytoplasm. The impression was that the marrow
showed changes of acute promyelocytic leukemia. A bone marrow biopsy showed hypercellularity and infiltration by abnormal cells. Despite extensive marrow involvement,
however, the patient did not have severe anemia or circulating abnormal cells when he
first presented
closely in che special lhmbtlacoty ‘thre c1 fot > Xe plan was to treat him for bleeding
episodes, the appearatide of blast cells if the perii@étal tBitod, Splenomegaly, or ;
deterioration of coaguPation pafameters. £°€6
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aic,cihe patient's plagelec a
count fell to 7,000,oaqd he d
oped an gaggche araithd a
e fever. He wasgt
9 .
therefore readmittedgarg] on October 15 begoee,on thecapy whithycytosine arabinoside, 200 mgIT
per meter squared intr¥venouslySévery 12 BOOte, and ‘S*thidgdanine 790 mg. per mater’?
squared orally everyS12 hours. °The reeBabe base+t ee 3
plastin time, thromb¥h. eime, £1
ogen, Fiftin sp
*hrody ts,
big’time, partial
factor VIII wer
oT
0-8
‘
within the normal raggq; nevertheless, beqayse of
Staage: tiongef intravascular gpagulgtion with acute progrgmlocyticojeukemia, shegwas tueaged arephylaecically with hepaodin, 3
0.5 mg. per kg. intravenously every 6 hours for firstfive days of chemorherapeutic
drugs. On the first day of treatment the white STPGR!cOie Gas 1,700 with 21% neutrophils, .
56% lymphocytes att 30%aye precursors; platelets were 32,000 (after transfusion)
Te
eee at
and hemoglobin 10.3.
ite count remained low throughout the remainder of his hos-
ital course; abnorma),foung disgppeaged from the peripheral blood on the ninth day of
treatment; platelet §54gs fusions,were o
ered
yee days in an effort to keep the platelet ,gount abque,720, 000.
1 bone
Erte
aki
ations revealed :ton, zt
day five, hypercelluker; marrow witb 80% oknertal cont
daaor:
pn: seyen, Mypwfiroeldantyrg «sc.
marrow with 90% progwdnnlocytersson day twette, hyyestelDutaae with 95% progtanulost
cytes; on day fourtedd, 'hyperdéllular mackie iich
n day ninetéen, ‘ST
normecellular marrow
h 80%
remo
Say
cr,t rece after twe
~twe
days of treatment, a
ell
T erat
normal prouyelocytes. 4, |
Qn the day prior to
th the pettent's.kh
obin gmag,3.
Sattatell count, 2,100,with ,7-:
100% lymphocytes, andcpiatelet equnt 11,000z+1 He hast zpacesred 10 waits of packed redz 91 blood cells and had Gécalved platéler traitd £60tons 0/18
aden
+4 of Ris hospital stay.?7
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During the last two
of. %{£6 he oeHA
ve
Yatelet count aftét
tt
platelet: transfusiong,. robably (facause Hi
transfusion.
Rongelap (54)
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