Three-Year-Old Child Presenting with Bruising, Lethargy, and Fever

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The page below is a sample from the LabCE course Case Studies in Hematology - Malignant WBC Disorders. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Three-Year-Old Child Presenting with Bruising, Lethargy, and Fever

A three-year-old male is brought to his pediatrician by worried parents, who said he was becoming increasingly lethargic and pale over the past two weeks. He started to bruise very easily and had a fever the past week.
The physician noted that the child appeared pale, had a fever of 101.8°F, and also complained his leg hurt. Upon examination, the child also had an enlarged liver. The physician ordered a complete blood count (CBC) with a differential and a chemistry panel.
Abnormal test results included:
Patient Results Reference Range
Hemoglobin (g/dL)7.1 12–15
WBC (× 103 /µL)52 6–16
Platelets (× 103 /µL)98 150–450
Percent blasts (%)860
LDH (U/L)58060–170
Uric acid (mg/dL)5.92.4–5.4