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Table 1 Clinical history of the patient together with diagnostic results and treatment

From: De novo adult acute myeloid leukemia with two new mutations in juxtatransmembrane domain of the FLT3 gene: a case report

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

  1. Ca2+, Calcium; LDH, Lactate dehydrogenase; UA, Uric acid; creat., Creatinine; Na+, Sodium; K+, potassium; TP, Total protein; Alb, Albumin ; PT, Prothrombin time; PTT, Partial thromboplastin time; INR, International normalized ratio; CRP, C-reactive protein; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; WBC, white blood cells; PB, peripheral blood; Hgb, hemoglobin; BM, Bone marrow; CT, computed tomography scan.