9 old boy brought with h/o tiredness of 2 months duration. he had h/o fever 1 month ago. No h/o skin bleeds/neck swelling. He has been treated with antibiotics. He is referred for high esr and tiredness.he has mild pallor, blue discoloration of i/v puncture site,hepatospenomegaly.his hb is 9gm%,tc 14,000/mm3 His esr is 35 mm/hr and platelet count is 34,000/mm3
Discussion :9 yr old child with pallor , skin bleed, hepatospenomegaly ,thrombocytopenia with normal esr indicate bicytopenia –which is most likely to be due malignancy or connective tissue disorder or histiocytosis. Normal esr with decresing platelet count is more in favour of malignancy. So for this child acute leukaemia -lymphoblastic type is the most likely diagnosis
Superintendent, ICH.