3rd Sessional Practical Examination , 2024

Case Study
on
LEUKEMIA

Presented to:- Presented by:-

Dr.Rohit Bangwal Vanlaltlansanga
Assistant Professor, Pharm D Roll No : 210429800026
Department of Pharmacy Pharm D, 3rd Year
SDBIT, Dehradun SDBIT, Dehradun

Date of Submission: 03/04/24 1

0
Introduction
• Leukemia is a type of cancer that affects the blood and bone marrow, where blood
cells are produced.
• It starts in the bone marrow, the soft tissue inside bones, where blood cells are
made. The disease often involves white blood cells, which are crucial for fighting
infection.
• In leukemia, the bone marrow produces abnormal white blood cells that don't
function properly. These abnormal cells multiply rapidly, crowding out healthy
cells. As a result, the body may not have enough normal white blood cells, red
blood cells, and platelets, leading to symptoms such as fatigue, infections, and
easy bleeding or bruising
• Leukemia can be acute or chronic, depending on how quickly it progresses and
whether the abnormal cells are immature or mature. Treatment typically involves
chemotherapy, targeted therapy, radiation therapy, and stem cell transplantation.
2
1
Subjective Data
• Patient Name : Dimple Anand
• Gender: Male
• Age: 15
• Weight: 56 kg
• Department : Oncology
• Ward: 10
• Date of Admission: 03/04/24

3
2
History
• Disease History: 1. Fever since 2 months
2. Pain in Throat from 10 Days
3. Difficulty in Respiration

• Medication History: No Medication History

• Family History: No Relevant Family History

• Social History: No Social History

4
4
Objective
• Chief Complaints:
• Air entry is decreased in bilateral lung
• Petechiae spots, splinter hemorrhages, bilateral conjunctival hemorrhage
present
• Swelling around Neck, Tongue, Lips, Face, Epiglottis
• Oral Mucosa is Edematous with Bluish Discoloration

• Physical Examination:
• Pale Skin
• Dry and Crack Lips
• Left Corneal Opacity
• Poor Hair Hygiene
5
3
Goals of Treatment
• Improves cure Rates – Identify patients who will fail current therapies and alter
approaches

• Decrease Acute and Late effects

• Optimize Medication Adherence

• Improves Airway Management

5 6
Vitals / Lab Data:
• Blood Pressure: 110/80 mmHg
• Heart Rate: 45 bpm
• Body Temperature: 120°F
• Respiratory Rate: 10 breaths/min
• Blood Oxygen: 81%
• Blood Glucose Level: 70 mg/dl
• Haemoglobin (g/dl): 5.5 g/dl

7
6
Lab Investigation:
PARAMETERS OBSERVED VALUE NORMAL VALUES

Hemoglobin 5.5 gm/dl 10-15.5 gm/dl

Total Leucocyte Count 3000/mm 5000-10,000/mm

Differential Leucocyte Count

Polymorphs 20% 40-74%

Lymphocytes 55% 18-45%

Esinophill 3% 6%

Monocytes 2% 4-8%

8
7
Lab Investigation:
• Bone Marrow Examination showed Predominantly blast cells

• Blood Culture was Sterile

• Widal Test Negative

• ECG - Bradycardia

9
Assessment
• Provisional Diagnosis – Acute Lymphoid Leukemia (ALL) L2 Type
• Final Diagnosis – Acute Lymphoid Leukemia L2 Type

8 10
Treatment:
S.NO Drugs Dose R.O.A Duration

1 Prednisone 60mg (TID) Oral 7-14 days

2 Mercaptopurine 50 mg (OD) Oral 7-14 days

3 Vincristine 2 mg/m2 IV 14 Days

( 1 minutes once
a week)
4 L-Asparginase 5 ml (OD) IV 14 Days

11
9
 Drug Interaction:
S.No Drug Name Classification M.O.A
1 Prednisone Corticosteroid 1. Cross cell membrane
and binds GRs
2. Undergoes
Conformational changes
and enter Nucleus
3. Interacts with specific
DNA-GREs and involved
in Transcription

2 Mercaptopurine Antimetabolite Inhibit Folic acid Syntesis

(Replace PABA)
3 Vincristine Vinca Alkaloids Binds Tubulin and inhibit
microtubule formation
4 L-Asperginase Enzyme Medication Catalyse the breakdown of
Aspergine into Ammonia
and Aspartic Acids through
Hydrolysis

12
10
Adverse Drug Effect
1. Insomnia
2. Tingling, numbness or weakness in hands and feet
3. Alopecia (Hair Loss)
4. Nausea and Vomitting
5. Itching , rash, and breathing difficulty
6. Constipation or Diarrhea
7. Liver Toxicity
8. Pulmonary Toxicity
9. Headache
10. Fatique

13
11
Patient Counselling
• Understanding the Diagnosis
• Treatment Options
• Medication Management
• Symptoms Management
• Nutrition and Hydration
• Emotional Support
• Follow-Up Care
• Lifestyle Modification
• Encouragement and Hope
12 14
15