Inpatient diabetes mellitus in the oncology setting

A.B. is a 32-year-old Caucasian man with a significant, 12-year medical history of diabetes mellitus type I as well as a history of hypertension and hypercholesterolemia. He presented to his primary care doctor with blurred vision and was referred to a retinal specialist, who diagnosed hemorhagic and leukemic retinopathy resulting in limited vision. A complete blood count was drawn during the visit with his retinal specialist. The results were abnormal, revealing a white blood cell count of 30,000/mm3, platelet count of 70,000/mm3, and a hemoglobin of 12.2 gm/dl. The peripheral smear showed peripheral blasts. A.B. was referred to a hematologist, who performed a bone marrow aspiration, confirming the diagnosis of pre-B-cell acute lymphocytic leukemia (ALL). Cytogenetic studies revealed positivity for the Philadelphia chromosome and a translocation of genes 4 and 11.