Blood test leucogram (manual method)

Blood form components: microxyphil – 1.0%; Blasts – 99.0%;

13.04.2013 Overall biochemistry: Total bilirubin – 14 mmol/l; general protein – 50 g/l; Albumins – 37.8 g/l; BUN – 1.52 mmol/l; Creatinine – 43 mmol/l; ALT – 49 ME/l; AST – 86 ME/l; glucose – 5.0 mg/l; Ca total – 2.49 mmol/l; Uric acid – 525 mmol/l; Phosphorous – 0.90 mmol/l;

15.04.2013 Cytology of bone marrow – the drug was hyper-cellular and monomorphic. Total infiltration 93.6% of bone marrow by blasts of medium and small sizes with high nuclear-cytoplasmic ratio, gentle nuclear chromatin and nucleolus 0-0-1.

Cytochemical examination – POX negative, PAS – positive in the form of 1-2 large granules in 11% blasts.

Diagnosis – Acute lymphoblastic leukaemia L1-L2.

15.04.2013 immunophenotyping if blast cells in the bone marrow in acute leukaemia Primary panel: CD3days - <1; CD79a – 95.0; MPO - <1; CD19 – 99.9; CD117 - <1; CD34 - <1; CD133 - <1; CD45 – 99.9; CD19 – 99.9; CD13 - <1; CD33 - <1; CD22 – 85.9; CD7 – 6.7; Conclusion: matches BIII-ALL;

15.04.2013 Immunophenotyping of blast cells in the bone marrow in acute leukaemia B-linear leukaemia: Lambda – 92.6; Kappa - <1; CD19 – 99.9; CD20 – 6.1; IgM – 69.2; CD10 – 90.7; CD58 - <1; CD45 – 99.9; CD19 – 99.9; CD34 - <1; Conclusion: Matches BIII-ALL;

Bone marrow test using FICH method on 11q23 dated 15.04.2013 – 100 nucleuses examined, displacement of MLL gene found in 40% cells. Bone marrow test using cytogenetic method dated 15.04.2013 – test not conducted (test failed).

Determination of translocation in bone marrow using PCR, dated 15.04.2013 – Found translocation t(9;11) MLL-AF9 with random primer; translocations of t(4;11), t(6;11), t(11;19), t(1;11) not observed.

Real time bone marrow test using PCR method, dated 15.04.2013 – observed expression of chimeric gene MLL-AF9 (t(9;11)), the value of standard number of copies is 303.64%.

17.04.2013 Cerebrospinal fluid test – leucocytes 0.3x10⁶/l, erythrocytes 0.3x10⁶/l, unchanged protein 0.432 g/l, xanthosis and Pandy’s reaction negative.

17.04.2013 Cerebrospinal fluid test using cytospin method – drug carried by blasts – 4, lymphocytes – 3, monocytes – 2, ependymal cell – 1.

17.04.2013 Immunophenotyping of blast cells in cerebrospinal fluid in acute leukaemia B-linear leukaemia: Conclusions: In cerebrospinal fluid on 17.04.2023 observed atypical tumour cells with phenotype CD45dim+CD10+CD19+ were determined; Conclusions: In cerebrospinal fluid on 17.04.2013 atypical tumour cells determined with phenotype CD45dim+CD10+CD19

17.04.2013 During bone marrow test using PCR method – Translocation of t(9;11) MLL-AF9 with random primer found.

13.04.2013 Urine test general: Colour – light yellow; Transparency – transparent; Specific weight – 1.000; pH – 6; Ascorbic acid – neg g/l; Sugar – norm mmol/l; Protein – neg g/l; Bilirubin – neg mmol/l; Ketone – neg mmol/l; Urobilinogen – norm mmol/l; Nitrite – neg; Leucocytes - neg Leu/ul; Erythrocytes – 10 Ery/ul.

15.04.2013 Lab tests of haemostasis and endogenic intoxication: Haemostasis for Total Homocysteine: Quantity of thrombocytes – 24; fibrinogen – 2.3; Activated Partial Thromboplastin Time (APTT) – 28.8; Prothrombine time – 16.1; Quick prothrombine – 69; International Normalized Ratio INR – 1.22; Orthofinantroline test (SFC) – 0; Thrombin time – 12.5; “R” – 4.12; “K” – unlimited; “MA” – 8; Hageman dependent enzymatic fibrinolysis per TE - >20; Factor VIII activity – 94; AT-III – 60.0; Protein C – 55.0; D-dimers – 2705; Conclusions: accented structural hypo coagulation due to deep thrombocytopenia, mild chronometric hypo coagulation, fibrinolysis stopped; high level of D-dimers, reduced activity of natural anticoagulants. Signs of excessive thrombinemia.

15.04.2013 PCR method – HBV, HCV, CMV, EBV, herpes type 6 virus, DNA Toxoplasma gondii not found in blood.

12.04.2013 – using ELISA method – No HIV antibodies found.

13.04.2013 X-ray examination of organs in the ribcage – deformation of lung image.

13.04.2013 Midsection ultrasound scan: Hepatolienomegaly, increase in kidney size, diffusional changes in liver and kidneys.

ECG 15.04.2013: Voltage – tends to decrease, ECA without deviations, sinus rhythm 120-139 per minute, moderate breach of ventricular repolarization.

15.04.2013 Echocardiogram: Contraction of myocardia is normal. Ventricle sizes not increased. Contraction parameters – EF – 66%, FS – 34%.

14.05.2013 Brain CT scan without contrast – Generalized cerebral atrophy 2 stage.

16.04.2013 Neurologist – PACNS (mixed genesis), rehabilitation period. Hypotonic syndrome with delay in motor development associated with main disease.

Treatment:

17.04.2013: Operation performed: Implant of right Broviak catheter.

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