Day of treatment | Symptoms | Analysis findings | Treatment and outcomes |
---|---|---|---|
1 |  | Serum biochemistry analyses: Calcium (Ca2+) 8.3 mg/dL (normal value 8.5–10.6) Lactate dehydrogenase (LDH) 558 U/L (normal level < 460) Phosphor 4.4 mg/dL (2.7–6) Uric acid (UA) 5.6 mg/dL (normal value 3.5–7) Creatinine (creat.) 0.7 mg/L (normal 0–5) Urea 17 mmol/L (normal 10–50) Sodium (Na+) 135 mmol/L (normal135–148) Potasium (K+) 4.5 mmol/L (3.5–5.2) Total protein (TP) 8 g/dL (normal 6.6–8.7) Albumin (Alb) 4.4 g/dL (normal 3.8–5.4) Bilirubine 5.1 mg/dL (normal 0–5) Glucose 101 mg/dL (normal 65–110). Prothrombin time (PT) 85% Partial thromboplastin time (PTT) 28.5 seconds International normalized ratio (INR) 1.1 seconds C-reactive protein (CRP) 43.8 mg/L (normal 0–5) | D1 of (3+7) protocol:  Daunorubicin 60 mg/m2 for 3 days and Cytarabine 200 mg/m2 for 7 days  Blood transfusion |
2 |  | Glucose 166 mg/dL (normal 65–110) | Patient was developed fever (39 °C), epigastric burning pain, no diarrhoea, cough with white mucus and pharyngeal congestion  Blood transfusion |
7 | PB showed WBC 3.9 × 109/L, anemia (Hgb 7.8 g/dL); thrombocytopenia (Plt 24 × 109/L) | Creat. 1.7 mg/L (normal 0–5) Urea 23 mmol/L (normal 10–50) Glucose 141 mg/dL (normal 65–110) | Blood transfusion |
13 | Patient was developed neutropenia (WBC 0.6 × 109/L), anemia (Hgb 7 g/dl); thrombocytopenia (Plt 2 × 109/L) | Creat. 0.9 mg/L Urea 40.9 mmol/L Glucose 117.4 mg/dL UA 2.7 Ca2+ 8.3 Phosphor 2.1 mg/dL (2.7-6) Alanine aminotransferase (ALT) 25.3 U/L (normal 0–45) Aspartate aminotransferase (AST) 51.5 U/L (normal 0–35) | Blood transfusion and broad-spectrum antibiotics |
30 | Patient was relapsed His PB showed: WBC 107 × 109/L, anemia (Hgb 8.8 g/dL); thrombocytopenia (Plt 93 × 109/L) BM smear showed almost 40% of blasts Submandibular lymphadenopathy (2 cm), fever (39.5 °C), cough with white mucus, and severe diarrhea Heart rate 89/minute | Ca2+ 9.2 mg/dL LDH 833 U/L UA 6.2 mg/dL Creat. 1 mg/L Urea 10 mmol/L Na+ 131 mmol/L K+ 3.2 mmol/L TP 6.2 g/dL PT 46% INR 1.6 seconds ALT 10.6 U/L AST 19.5 U/L | Re-induction (3 + 7) protocol Patient was developed sever neutropenia (WBC 0.5 × 109/L), anemia (Hgb 7.1 g/dL); thrombocytopenia (Plt 9 × 109/L) Blood transfusion and broad-spectrum antibiotics |
38 | Patient was developed sever neutropenia (WBC 0.0 × 109/L) was continues for 2 days later, anemia (Hgb 6.5 g/dL); thrombocytopenia (Plt 1 × 109/L) Fever (39–39.5 °C) was continues for the next 7 days | K+ 3.3 mmol/L CRP 300 mg/L Procalcitonine 68 ng/mL (normal 0.1–0.49) | Neutropenia, abdominal pain, right iliac fossa pain, and severe diarrhoea Blood transfusion and broad-spectrum antibiotics  Abdomen CT scan showed: Multi-focal of splenic lesions (2 cm) which consistent with secondary metastasis, ascending colon wall thickness (1.7 cm), cecum wall thickening until the appendix (1.5 cm) with fatty infiltration which is consistent with neutropenic enterocolitis, Paraaortic lymph node enlargement (0.8 cm), bone scan shows degenerative changes and free fluid in abdomen and fatty infiltration (appendicitis). |
40 | His PB showed: WBC 1.5 × 109/L, anemia (Hgb 6.1 g/dL); thrombocytopenia (Plt 1 × 109/L) | PT 71% INR 5.3 seconds K+ 2.6 mmol Glucose 128 mg/dL Urea 56 mmol/L Creat. 0.6 mg/L Na+ 152 mmol/L | Blood transfusion and broad-spectrum antibiotics |
46 | He suffered from fever more than 39–39.5 °C and neutropenia for more than 7 days |  | Approximately 3 months after initial diagnosis he died due to respiratory and cardiac arrest No autopsy was performed |