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RD TH TH TH TH TH TH TH
RD TH TH TH TH TH TH TH
April 17th,2019 April 30th, 2019 May 7th, 2019 June 3rd, 2019 June 4th-8th, 2019 March 9th-10th, 2019
Admitted to hospital with Pale (+), fever (+), bone Pale (+), fever (+), Pale (+), fever (-), bone Pale (-), fever (-), bone Pale (-), fever (-), bone
complaints: pale, bone pain pain (-), bleeding (-) bone pain (-), bleeding pain (-), bleeding (-) pain (-), bleeding (-) pain (-), bleeding (-)
and fever (-)
Supportive examination: PE: Head: anemic PE: Head: anemic PE: Head: anemic PE: Head: anemic
PE: Head: anemic BMP :predominance with conjunctiva (+), anicteric conjunctiva (+), anicteric conjunctiva (-), anicteric conjunctiva (-), anicteric
conjunctiva (+), anicteric lymphoblast L2 morphology sclera.Abdomen: Liver 4-4 sklera, Abdomen: Liver 3- sklera, Abdomen: Liver 3- sklera, Abdomen: Liver 3-
sclera.Abdomen: Liver 4- with blast and smudge cells cm BCM, spleen schuffner 3 cm BCM, spleen 3 cm BCM, spleen 3 cm BCM, spleen
4 cm BCM, spleen Immunophenotyping : B III schuffner II schuffner II schuffner II
schuffner III lineage with gating of the blast
with positive HLA-DR, CD10,
CD19, CD20.
Laboratory: CSF exam : Working diagnosis: Laboratory: Hb: 10.5g/dl, Hct
cloudy, leukocyte 600/L, High Risk B-cell ALL + Laboratory: Hb:10,2 g/dl,
: 30.5 %, leukocyte 5.500/L,
Laboratory : Hb : 2.7 g/dl, nonne (+), pandy (+), blast CNS Leukemia (C91.00) leukocyte 4.200/L,
trombocyte 103.000/ul, ANC
leukocyte 202.900/L, Working diagnosis: (+) thrombocyte 85.000/ul,
5.060 cell/ mm3. AST :35 U/L
trombocyte 17.000/L, High Risk B-cell ALL ANC 4,032 cell/ mm3.
ALT: 20 U/L. Ur 21 mg/dL, Cr
blood smear : Suggestive: 0.5 mg/dL. Sodium 136,
ALL
potassium 4.0, Calcium 8.0,
Working diagnosis: Therapy :
Therapy: High Risk B-cell ALL + CNS - High-risk ALL consolidation
Working diagnosis:
- Nutrition according Leukemia (C91.00) phase Indonesia Protocol
High Risk B-cell ALL +
to RDA 2016 +CNS Leukemia Working diagnosis:
Working diagnosis: CNS Leukemia (C91.00)
(Modified) High Risk B-cell ALL +
Suspect ALL
- Nutrition according to RDA CNS Leukemia (C91.00)
Therapy :
- High-risk ALL induction
Therapy :
phase Indonesia Protocol
Therapy: - High-risk ALL Therapy :
2016 +CNS Leukemia
- PRC and platelet transfusion consolidation phase - High-risk ALL consolidation
(Modified)
- Nutrition according to RDA Indonesia Protocol 2016 phase Indonesia Protocol
- Nutrition according to RDA
Plan: BMP and immuno- +CNS Leukemia 2016 +CNS Leukemia
phenotyping (Modified) (Modified)
- Nutrition according to - Nutrition according to
RDA RDA