1. Case Presentation Omneya Ahmed Mona Haermel

2. A.A. is a 15 years male patient who was diagnosed AML-M5. The condition started with abdominal pain, nausea, vomiting and headache followed by darkening of urine colour which lasted for 17 days before coming to the hospital. Acute leukemia was suspected. CBC, LF, KF, hepatitis profile, CT,CXR and bone aspiration were ordered.

3. CBC (22/4) showed a TLC 149000/cmm, pt 135000/cmm, Hg 8.6 g/dL, Neutrophils 0, Blasts 88%. Clinical Chemistry Report showed(22/4) ALT 219 IU/L, AST 148 IU/L, LDH 1810 IU/L, T. Bilirubin 15.40 mg/dL, D.Bilirubin 9.5mg/dL, Uric acid 5.7 mg/dL, K 3.2mmol/L, Calcium-Total 8.6 mg/dL, P 1.8mg/dL, Mg 2.3 mg/dL. Abdominal ultrasonography showed moderate hepatosplenomegaly without obstruction.

4. On the 23 rd April the patient developed fever 38.5Cº. He was started on IV antibiotics Cefoperazone – Sulbactam 60mg/kg and amikacin 15mg/kg. The patient was given IV fluids 2750mL/m 2 together with alkalanization in addition to allopurinol. The patient was to start his first induction course ADE but due to high bilirubin level Etoposide and doxorubicin were omitted. The patient was started on cytarabine with 50mg/m 2 /Q12h that was to be increased to 100 mg/m 2 /Q12h if tolerated.

5. On the 23 rd April the patient started his first dose of cytarabine. On the 24 th ALT 142 IU/L, AST 135IU/L, Albumin 2.2, T. Bilirubin 13.6mg/dL, D. bilirubin 8.20mg/dL. As T.bilirubin and liverenzymes decreased and hepatitis marker, CMV, EB virus are negative the cytarabine dose was increased to 100mg/m 2 /Q12h.

6. Today 28 th April the patient is afebrile, no oral mucositis, diarrhea or vomiting. Hg 7.1g/dL, Pt 74000/cmm, TLC 1700/cmm. ALT 129IU/L, AST 125IU/L, T.Bilirubin 9.3mg/dL, C.Bilirubin 5.3mg/dL.

7. Today 30 April T. bilirubin is 8.6mg/dL and D.Bilirubin is 4.6mg/dL. Doxorubicin and Etoposide are to be at full dose if albumin is more than 2.5g.