70 yo M with SOB

CASE:

70 year old man with history of asthma presents to primary care clinic with 2 weeks of progressive SOB not relieved with home albuterol. He had received a 5 day course of prednisone 20mg and azithromycin with no noticeable improvement. He now returns a week later with a fever, increasing fatigue, persistent SOB and now a mild non-productive cough. He denies nasal congestion, sore throat, chest pain, palpitations, weight changes, orthopnea/PND, or skin changes. No sick contacts or recent travel.  He uses albuteral as needed for his asthma and drinks a cup of colloidal silver every day to prevent the flu. On exam, he is afebrile, HR 88bpm, BP 120/76 and SpO2 93 % on RA.  He appears comfortable, normal heart heart with regular rhythm, no murmurs or elevated JVD. He has bibasilar crackles and a soft, non-tender abdomen.  No visible rashes.

Labs

WBC 142k (ANC 0, 81% blasts), Hct 15%, Plt 30
Cr 1.1, K 3.5, Ca 8, Phos 2, Uric acid 7.9

Blood smear
smear 1

Based on this patient’s CBC and blood smear what disease process do these blasts cells represent?


What are the major acute complications of this diagnosis and how might you prevent some of these complications?


CXR

PA

Based on his clinical presentation what are the potential explanations for his shortness of breath and the above CXR findings?

How would you manage this?


OUTCOME:

TAKE HOME POINTS:


REFERENCES:

  1. Howard SC, Jones DP, Pui CH. The Tumor Lysis Syndrome. N Engl J Med 2011; 364:1844.

ADDITIONAL RESOURCES:

AML and ALL review for the internist

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