ACUTE

MYELOID
LEUKEMIA
(AML)
Block 2-B

Anna Marie Serenio Daryll Soltero

Abdisa Kurfessa Estefania Caurica
Karlyne Catubig
 Date Aug, 22, 2018. (Bulacan)

HEMATOLOGY Result Unit Range

CBC
RBC Low 4.0 10˄12/L 5.50-5.40

Hemoglobin Low 1.2 g/L 120 to 160

WBC High 26.8 10^9/L 5.00 to 10.00

Hematocrit Low 0.35 L/l 0.38 to 0.47

Lymphocytes 25 % 25-40

Segmenters Low 44 % 54-75

Monocytes High 28 % 2-8

Platelet count Low 26 10^9/L 150-450

Peripheral blood smear

Review of the peripheral blood smear confirms the findings from the CBC count. A sample of blood is looked at under the microscope. Changes in the
numbers and the appearance of different types of blood cells often help diagnose leukemia.

 Peripheral blood smear show decreased RBC

 Normocytic normochromic
 WBC is approximately 15*
Segmenters 0.9
Lymphocyte 0.27
Eosinophils 0.03
Monocytes 0.02
Blast 0.49
Platelet count is approximately < 20.00
Impression:
Acute leukemia

Patients with AML have too many immature white cells in their blood, and not enough red blood cells or platelets. Many of the white blood cells may be
myeloblasts (often just called blasts), which are very early forms of blood-forming cells that are not normally found in the blood. These cells don’t work
like normal, mature white blood cells.
Aug.28 , 2018
HEMATOLOGY RESULTS UNIT RANGE
RBC Low 3.02 10˄12/L 4.50-5.40

HCT Low 0.28 L/l 0.38 to 0.47

HBG Low 89 g/L 120 to 160

WBC High 17.60 10^9/L 5.00 to 10.00

lymphocytes Low 20 % 25-40

Eosinophils Low 0 % 1-4

Segmenters Low 32 % 54-75

Platelet Count Low 16 10^9/L 150-450

MCHC Low 31.5 g/dl 32.0-36.0

Aug, 26, 2018

COAGULATION RESULTS UNIT RANGE

PROTHROMBIN TIME Patient High 14.7 sec seconds 11.4-14.4

ACTIVITY 87.7 % %

INR 1.12
. Aug, 26, 2018

CLINICAL CHEMISTY RESULTS UNIT RANGE

Direct Bilirubin (Bc) High 7.0 Umol/L 0-5

Alkaline phosphatase High 127 U/L 42-98

SGPT High 71.0 U/L <34

Potassium (K+) Low 3.5 mmol/L 3.5-5.1

NOV,13, 2018

CLINICAL RESULT UNIT RANGE

CHEMISTRY
SGPT 15.0 u/L 9-52

CREATININE LOW 53.0 Umol/L 62-106

AUG, 27, 2018

CLINICAL MICROSCOPY RESULTS UNIT RANGE
COLOR Light Yellow
TRANSPARENCY Slightly Hazy
VOLUME 30 ml
CHEMICAL
SPECIFIC GRAVITY 1.005
PH 6.0
GLUCOSE Negative
 KETONE Negative
BLOOD +++
PROTEIN Negative
URINE NITRITE Negative
LEUCOCYTE ESTERASE Negative
MICROSCOPIC RESULT UNIT RANGE
WBC 1.0 /HPF 0-5
RBC High 21.0 /HPF 0-2
EPITHELIAL CELL 0.0 /HPF 0-3
BACTERIA 21.0 /HPF 0-50
+MUCUS THREADS 3.0 /HPF 0-3
CASTS 0.0 /LPF 0
BOOLD CS WITH Antimicrobial Removal Device (ARD)

Blood culture are used to detect the presence of bacteria or fungi in the blood, to identify the type present, and to guide
treatment.

0ct, 26,2018 Oct, 26,2018

Left Arm
Identified organism Left Arm
(1) Kelbsiella pneumonia Result
Right Arm Positive at 17 hours of incubation

Positive at 17 hours of incubation Right Arm

(1 ) Staph Areus (MRSA) Positive at 17 hours of incubation

Oct, 5, 2018

BONE MARROW, FLOW CYTOMETRY

Clinical Data or diagnosis: The patient is a diagnosed case of Acute myeloid Leukemia (NKTI FC18-1370, 8/3/2018). Surveillance
immunopenotyping

Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and
pancytopenia.

Flow cytometry is a computer-assisted technique in which bone marrow or other cells are treated with special antibodies and then placed in front
of a laser beam. Some types of leukemia cells contain binding molecules called receptors that cause the antibodies to "label" (stick to) them.
Laser treatment makes the antibody-coated cells fluorescent.

Immunophenotyping is process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to
diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system

Procedure result

No significant finding abnormal blast population detected

 Sep,20,2018
Ultrasound
Procedure kidneys, ureters, bladder (KUB)

A kidney, ureter, and bladder (KUB) X-ray may be performed to assess the abdominal area for causes of abdominal pain, or to assess the organs and
structures of the urinary and/or gastrointestinal (GI) system to check the kidneys for leukemia-related damage. A KUB X-ray may be the first diagnostic
procedure used to assess the urinary system.

X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external
radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissues onto specially
treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film). Digital films
and digital media are more commonly used now than the film media

PROCEDURE RESULT

The indication for the patient is to identify if there any damage or any change that occur due to the chemotherapy effect Some chemotherapy drugs can
affect the kidneys The kidneys also get rid of the chemo drugs when they've been broken down in the body, so they need to be working well.
The right kidney measures 12.3 *4.9 *6 cm (LWH) with a cortical thickness of 1.9 cm. while the left kidney measures 12.3* 5.3 cm (LWH) with cortical
thickness of 2.3 cm. the renal parenchyma is normal in echotexture with no focal lesion noted. There is no mass, lithiasis nor pelveocaliectasia.
The urinary bladder is distended with unthickened walls. No intraluminal echoes are seen.
INDICATION FOR PROCEDURES

The indication for the patient is to identify if there any damage or any change or abnormalities of the kidney, uterus, bladder, a result of structural
defects or tumor Determination of changes in the size, shape, and position of the kidneys, that may occur due to the chemotherapy effect.
AUG, 27,2018

2-D Doppler ECHOCARDIGRAPHY

A Doppler echocardiogram measures the speed and direction of the blood flow within the heart. It screens the four valves for
leaks and other abnormalities. By assigning color to the direction of blood flow, (Color Flow Mapping), large areas of blood flow
may be studied. These color flow mappings allow abnormal blood flow characteristics to be interpreted by the cardiologist.

ECHOCARDIOGRAPHIC INFORMATION
interpretation: the patient undergoes chemotherapy treatment have an increased risk of developing cardiac toxicity.
Continuous monitoring of a patient under this treatment is the best way to detect and establish an early diagnosis of cardiac
toxicity. Echocardiography plays a definitive role for this assessment. These techniques may enable more sensitive detection of
early changes in myocardial function before those detected by traditional methods.
M-mode/2D Measurements:

EF 55-77%
LVEDD 4.3 4.0-5.0cm RV (R-L) 2.9 22-3.5 cm
Cube
Teicholz 77 RA (R-L) 3.3 30-3.5 cm
LVESD 2.3 cm
Simposon’s
LA (A-P) 3.7 2.6-3.6 cm
FS 46 28-41% IVS (D) 1.5 0.7-1.1cm
LVEDV 79 Cc
LA (R-L) 3.4 30-3.5 cm
LVESV 12 Cc LVS (S) 1.8
SV 67 Cc/beat
LVPW (D) 1.5 0.7-1.1cm Aorta 3.1 3.0-3.5 cm
CO 5.0 L/min
RV (R-L) 2.9 22-3.5 cm
LVPW (S) 1.9 Annulus
RA (R-L) 3.3 30-3.5 cm
LA (A-P) 3.7 2.6-3.6 cm Sinus
EPSS 0.40 <1cm
LA (R-L) 3.4 30-3.5 cm
Aorta 3.1 3.0-3.5 cm PA 2.5 3.0-3.5 cm Prox. Asx
Annulus
Sinus LVOT 1.94 cm AV OP 2.0 3.5-2.0 cm
Prox. Asx
AV OP 2.0 3.5-2.0 cm
September,02,2018

RADIOLOGICAL: CHEST

Results
there is minimal left basal pneumonia.
Heart is mildly enlarged.
Aorta is atherosclerotic
other chest finding are unremarkable.
Interpretation: the indication of chest x-ray for the patient is to see there is any changes that affected by
chemotherapy, because chemotherapy drugs can affect the muscles of the heart. This could change the
rhythm of your heartbeat.
Risk for Risk for Short Term Goal: Independent: 1. Most individuals are not Short Term: Short Term:
Bleeding Bleeding r/t After 8 hrs. of Nursing 1. Explained to the familiar with the complexities Skin will remain Intact with no Client skin was intact and no
Decreased Intervention, the client will be Patient and significant others the of the haematological signs of bleeding signs of bleeding
Subjective: Platelet Count able to identify individual risks symptoms of thrombocytopenia system. A successful plan
as evidenced and engage in appropriate and the functions of platelet requires the knowledge and
Mucous membrane will remain Mucous membrane intact
by Lab Results behaviours or lifestyle changes count. cooperation of the patient
intact
<16 to prevent bleeding -Normal range of platelet count and family members. (Meg Urine and stool free of blood
-Effects of thrombocytopenia Gulanick. Judith L. Myers)
Urine and stool will remain free
Long Term Goal: After 2 days Rationale of bleeding of blood Short Term:
of Nursing Intervention, the precaution. Patient does not experience
patient will takes measures to Short Term: bleeding as evidenced by normal
Objective: Risk prevent bleeding and 2. Instructed patient in 2. An understanding of Patient takes measures to blood pressure, stable
for bleeding recognizes signs of bleeding precautionary measure. Initiate precautionary measures prevent bleeding and hematocrit and hemoglobin
related to that need to be reported bleeding precautions for a reduces the risk for bleeding. recognizes signs of bleeding levels and desired ranges for
reduced immediately to a health care platelet count less than At platelet counts of that need to be reported coagulation profiles.
platelet counts professional. 50,000/mm3: <20,000/mm3 immediately to a health care
and Spontaneous professional.
suppression of Bleeding can occur.
bone marrow. (Meg Gulanick. Judith L.
Myers)
A. Generic name A. Indication Drug Action A. Side effects Nursing Responsibilities &
(Brand name) B. Other uses B. Contraindication Health teaching
B. Classification C. Dose C. Special
consideration