A Case of Acute lymphoplastic leukemia

A case of acute lymphoplastic leukemia

Jencia^1*, Subadhra Devi², Maha Lakshmi³

¹Haematology Department Nursing Incharge, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

An 18-year-old male had fatigue, breathlessness, nausea, vomiting, and headache for 15 days. He was treated for ear infection, but symptoms did not improve. Tests showed pancytopenia, and he was diagnosed with B-cell Acute Lymphoblastic Leukemia. He was referred for further treatment.

Key words: Acute Lymphoblastic Leukemia; Bone marrow

Introduction

Acute Lymphoblastic Leukemia is a blood cancer affecting bone marrow. B-cell Acute Lymphoblastic Leukemia is a common type. It causes symptoms like weakness, infection, and bleeding. Early diagnosis and treatment are important.

Case Presentation

An 18-year-old male had complaints of fatigue, dyspnoea on exertion, nausea, vomiting and headache for the past 15days.He had a recent history of ear infection treated with oral antibiotics and steroids. Despite treatment, his symptoms persisted and he was found to have pancytopenia at a local hospital. He was referred for further evaluation and management. On admission investigations confirmed B-cell Acute Lymphoblastic Leukaemia.

Social History: He does not have any social history of cigarette smoking, alcohol addiction.

Allergies: No known medicine or environmental allergies

Past Medical History

Recent ear infection (NOV 2025)
There is no other past medical history.

Physical Examination

Vital signs

Temp	100.4-degree Fahrenheit
HR	124/min
RR	28/min
BP	100/60 mmHg
Spo2	99%

Neurological examination: Patient conscious and oriented.

Relevant Investigation

Haemoglobin	3.5
Packed cell volume	10.2
Total WBC count	440
Neutrophil	4.6
Absolute neutrophil count(ANC)	20
Platelet count	1000
Urea	136.96
Creatinine	2.67
Potassium	5.64 mmol/L
Sodium	135 mmol/L
Total Bilirubin	2.17
Total Protein	5.62
AST/SGOT	671.0
ALT/SGPT	436.7
Blood group and Rh type	B positive

Imaging examination – MRCP images

The patient presented with pancytopenia and systemic symptoms. Laboratory investigations showed anaemia, leukopenia, thrombocytopenia, elevated LDH, hyperuricemia, and deranged renal function. Bone marrow examination confirmed acute leukaemia and immunophenotyping established B-cell ALL cytogenetics showed a normal karyotype and FISH panel was negative. The patient developed spontaneous tumour lysis syndrome leading to acute kidney injury, which required haemodialysis. blood cultures revealed Klebsiella pneumonia infection which was treated successfully with antibiotics.

Diagnosis

B cell acute lymphoblastic leukemia
Cytogenetics – Normal karyotype
Fish panel – Negative
NGS RNA panel – Negative
NGS DNA panel: flt3-itd (allelic ratio=0.47)
Spontaneous tumour lysis syndrome
On GMALL induction since 08.12.2025
Febrile neutropenia
Klebsiella pneumoniae (ESBl) bacteraemia – resolved
Acute kidney injury – resolved
Acute liver injury – resolved

Management

Bone marrow aspirate and trephine biopsy were consistent with that of acute leukaemia. Immunophenotyping showed features of B cell acute lymphoblastic leukaemia. FISH panel was negative. The NGS DNA panel showed mutations in FLT3 and ITD. NGS RNA panel showed no mutations. The patient was started on GMALL induction chemotherapy protocol on 08.12.2025, which included dexamethasone followed by oral prednisolone, danorubicin, vincristine, and intrathecal methotrexate. Cerebrospinal fluid (CSF) analysis showed no evidence of cerebral nervous system involvement He also received supportive care of single donor platelets, random donor platelets, packed red blood cells and granulocyte colony-stimulating factor (G-CSF).

The patient tolerated chemotherapy without major transfusion related complications. Risks of infection and bleeding were explained to the caregivers. Following stabilization, the patient was discharged in stable condition with advice for regular outpatient follow-up.

Inj.Dexamethosone, Tab.Prednisolone, Inj.Daunorubicin, Inj.Vincristine, Intrathecal methotrexate for CNS prophylaxis.

Outcome: He is discharged with stable condition and advised reviewing on OPD basis for further follow up.

Nursing Management

Vital Signs: Hourly monitored temperature, BP, HR, RR, and SpO₂.
Regularly GCS assessed for altered sensorium.
Monitored urine output report oliguria/anuria.
Closely monitored WBC, LFTs, RFTs, ABG, and coagulation profile.
Timely administered IV antibiotic as per prescription.
Administered IV fluids/blood products as per doctor advice
Administered timely chemotherapy medications as per doctor advice
Strictly followed aseptic technique during all procedures (e.g., catheter care, IV lines).
Patient Isolated to reduce the risk of infection
Three times a day tubing care Inspect for signs of local infection.
Fall Prevention followed Use of side rails, bed alarms for altered sensorium.
About the patient details and signs and symptoms education given to family members clearly.
Provided to patients (if conscious) holistic care.

Discharge Medications

Regular chemotherapy cycles.

S. No	Drug Name	Strength	Frequency	Relationship with meals	Days
1	Tab. Wysolone	40 Mg	BD	After Food	Till Review
2	Tab. Sepmax	800 Mg/160 Mg	OD	After Food	Alternative Days
3	Tab. Rantac	150 Mg	BD	Before Food	Till Review
4	Tab. Folvite	5 Mg	OD	After Food	Till Review
5	Syp. Looz	10 ML	TDS	After Food	Till Review

Discussion

B-cell Acute Lymphoblastic Leukemia is a common blood cancer that often presents with non-specific symptoms such as fatigue, fever, and vomiting, which can be mistaken for simple infections. In this case, the patient was initially treated for an infection, leading to a delay in diagnosis. The presence of pancytopenia played a key role in identifying the condition. This case highlights the importance of considering serious illnesses when symptoms persist and the need for early investigation and timely diagnosis to prevent complications.

Conclusion

The case represents a serious haematological malignancy, B-cell acute lymphoblastic leukaemia complicated by tumorolysis syndrome, infection, and acute kidney injury. Early diagnosis prompt initiation of chemotherapy aggressive supportive care and multidisciplinary results in clinical stabilization. Continuous follow-up and adherence to treatment are essential to improve prognosis and prevent complications.

A Case of Acute lymphoplastic leukemia

A case of acute lymphoplastic leukemia

Jencia1*, Subadhra Devi2, Maha Lakshmi3

Nightingale Journals

Jencia^1*, Subadhra Devi², Maha Lakshmi³