Acute Precursor B-Cell Lymphoblastic Leukemia in a 1-Year-Old White Male: Diagnostic Evaluation and Flow Cytometric...

1-year-old white male.

Bruising, pallor, and decreased activity.

Bruising had first been noticed on both lower extremities 3 weeks before the day he arrived at the hospital seeking treatment. The patient experienced a fall at that time that resulted in a lip laceration, which resolved spontaneously without increased bleeding time. His activity level was normal until the day of hospital admission, when he was noticed to be somewhat lethargic and pale. He was brought to the Emergency Department after 2 episodes of epistaxis, which resolved spontaneously.

Treated with amoxicillin the previous week for tonsillitis.

Mother has history of anemia.

The patient appeared pale and tired, with dry and pale oral mucosa. Dried blood was noted on the nares bilaterally. The boy was noted to have extensive ecchymosis to the upper and lower extremities, chest, and back; he was also noted to have moderate petechiae with a similar distribution. No organomegaly or lymphadenopathy was present, but mild abdominal distension was noted.