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All Journal Muhammadiyah Medical Journal Indonesian Journal of Cancer
Tedja, I Gusti Ayu Wiradari
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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A Patient with Suspect Chronic Myeloid Leukemia: A Case Report Dharmawaiswari, Anak Agung Ayu Ratih; Tedja, I Gusti Ayu Wiradari; Prianggandanni, Made Ayu Vita; Dharmawati, I Gusti Agung Ayu; Bekti, Heri Setiyo
Muhammadiyah Medical Journal Vol 5, No 2 (2024): Muhammadiyah Medical Journal (MMJ)
Publisher : Faculty of Medicine and Health Universitas Muhammadiyah Jakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24853/mmj.5.2.116-121

Abstract

Chronic myeloid leukemia (CML) is a type of cancer that starts in the blood-forming cells of the bone marrow. In contrast to other types of leukemia, chronic myeloid leukemia (CML) progresses slowly. This report covers a 52-year-old male patient who came to the emergency room at Wangaya Regional Hospital with weakness, nausea, and pallor. His weight had drastically decreased over the last few months. The clinical condition of the patient was that both eyes appeared anemic, and the abdominal examination revealed hepatomegaly. Complete blood count examination results showed the following results: leukocytes 222.73x103/µl, hemoglobin 7.3 g/dL, platelets 679x103/µl, neutrophil 87.5%, neutrophil/lymphocyte ratio 16.66%. The results of peripheral blood smear analysis showed that hyperleukocytosis, with the maturation stage of myelocyte cells with a percentage of myeloblasts 6%, promyelocytes 7%, myelocytes 6%, metamyelocytes 8%, neutrophils 10%, neutrophil segments 60%, other cells 3%. These examination results suggest chronic myeloid leukemia. However, to confirm the diagnosis, the BCR-ABL fusion protein must be expressed, which can be used to identify the presence or absence of the Philadelphia chromosome in patients diagnosed with chronic myeloid leukemia (CML).
Acute Myeloid Leukemia in a Three-Year-Old Girl Mimicking Chronic Myeloid Leukemia in Blast Crisis, Challenge in Diagnosis and Treatment in Limited-Resourced Health Care Facility: A Case Report Predani, Ni Luh Putu Diaswari; Gunawan, Andre; Mustika, Putu Pradnyanita; Tedja, I Gusti Ayu Wiradari
Indonesian Journal of Cancer Vol 18, No 1 (2024): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i1.1073

Abstract

Introduction: : Acute myeloid leukemia (AML) is the second most common hematologic cancer in childhood. Clinically, AML has similar symptoms to other types of leukemias, and diagnosis remains a challenge due to limited access to pediatric hemato-oncology diagnostic examination. This study aims to report AML in a 3-year-old girl who was first suspected of Chronic Myeloid Leukemia (CML) in blast crisis, using a combination of clinical-hematology parameters and conventional morphology examination in a limited-resourced healthcare facility. Case Presentation: A 3-year-old girl was referred from a rural Eastern Indonesia hospital with symptoms of prolonged fever, leucocytosis, severe anemia, and severe thrombocytopenia. In the previous hospital, the patient had a history of hyperleukocytosis and peripheral blood smear suspected of CML in blast crisis. A peripheral blood smear was repeated in our hospital and showed findings of Auer rod cells suggesting AML. Two bags of packed red cells and 2 thrombocyte concentrations were administered before referral for further diagnostic evaluation with bone marrow aspiration. Bone marrow aspiration revealed multiple nucleoli suggested for AML with FAB classification as M4 subtypes, and she received chemotherapy in a tertiary hospitalConclusions: With limited resources, suspicion based on persistent clinical symptoms, routine hematology tests, and peripheral blood smear examination are important to distinguish AML from CML in blast crisis. Understanding clinical hematology parameters and peripheral blood smears is the first step in AML diagnosis pathway and decision for further diagnostic referral. Supportive therapy and early recognition of oncologic emergency must be done before referral to a tertiary referral hospital.
Co-Authors Andre Gunawan Dharmawaiswari, Anak Agung Ayu Ratih Heri Setiyo Bekti I Gusti Agung Ayu Dharmawati Mustika, Putu Pradnyanita Predani, Ni Luh Putu Diaswari Prianggandanni, Made Ayu Vita