1. Prof.K.H.NOORUL AMEEN’s Unit Dr.E.Thirulogachandar

8. Cranial nerve right left Olfactory N N Optic nerve-visual acuity field colour vision fundus 6/6 Equal Normal Papillodema+ 6/6 Equal Normal Papillodema+ 3,4 and 6 nerves- extraocular movements Light reflex Accomodation reflex weak Equal Convergence absent Weak Nystagmus+ Equal Convergence absent 5 th nerve Normal normal 7 th nerve normal LMN palsy 8 th nerve normal normal 9&10 th nerve weak weak 11 th nerve weak weak 12 th nerve - LMN palsy

14. CBC-Hb-9gm% 31/8/10 X ray chest PA view-normal TC-4200 ECG-WNL DC-P53L43E2 URINE R/E-NORMAL ESR-15/32 Na-142 MCV-77fl K -4.1 MCH-28.8 MCHC-33.5 SERUM-UREA-42mg/dl CREATININE-0.9mg/dl SUGAR-90 mg/dl

21. LP CSF ANALYSIS Sugar 51 mg/dl (2/3 ofblood sugar) Protein 225mg/dl (40-60mg/dl) Cell count Acellular C & S (for pyogenic) NO GROWTH Chloride 113mEq/L(Normal 95-114)) Gram’s Staining AFB staining No Organism seen Negative

24. 6/9 RPT CBC-Hb-11.0GM 10/9/10 CBC-HB-4.1GM TC-4200 TC-3200 DC-P48L52 DC-P50L48E2 ESR-2/5 ESR-28/52 PLT-1.0 LAC PLT-<20000 MCV-90.6 MCH-30.6 MCHC-31.2 RBC-3.4 Million RBC-1.55 Million PS STUDY -THROMBOCYTOPENIA PS STUDY-THROMBOCYTOPENIA

27. HAEMATOLOGY-CBC-Hb-5.1 GM TC-7200 DC-P3L10Atypical cells87% PCV-15% ESR-45/95 PLATELETS-5000 PS STUDY-RBC-normocytic normochromic WBC-dec.neutrophils,atypical mononuclear cells PLT-REDUCED BMA –Dilute marrow,BLASTS-90%, Nuclear&cytoplasmic vacuolation ACUTE LEUKEMIA-ALL –L3

29. Copyright ©2007 American Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2007;2007:6-00053 Figure 1. Blasts appear small with a thin rim of cytoplasm

34. 12-year-old boy with acute lymphocytic leukemia presenting with severe headache

35. AML ALL

41. Clinical features Feature Children Adult Age (years) <1 2 — 1–9 72–78 — 10–19 20–26 — 20–39 — 55 40–59 — 36 ≥ 60 — 9 Male 56–57 62 Symptoms Fever 57 33–56 Fatigue 50 ? Bleeding 43 33 Bone or joint pain 25 25

42. Lymphadenopathy None 30 51 Marked (>3 cm) 15 11 Hepatomegaly None 34 65 Marked (below umbilicus) 17 ? Splenomegaly None 41 56 Marked (below umbilicus) 17 ? Mediastinal mass 8–10 15 CNS leukemia 3 8 Testicular leukemia 1 0.3

43. CNS status* paediatric adults CNS1 67–79/60 92–95 CNS2 5–24/27 ? CNS3 3/3 5–8 Traumatic lumbar puncture with blasts 6–7/10 ? Leukemic blasts in marrow (%) <90 33/46 29 >90 67/54 71 Leukemic blasts in blood Present 87/90 92 Absent 13/10 8