[frostfire]

great case, although my heart still sank when I got to :

Originally Posted by Doczilla

Bone marrow aspiration revealed acute myelogenous leukemia.

Originally Posted by Doczilla

Learning points:
AML is not a diagnosis that anyone makes in the ED. A prudent workup and high index of suspicion will ensure that danger signs are not missed and the patient is referred for appropriate follow up testing.
He was pancytopenic. He is anemic not only from poor production, but also GI blood loss. His low level of WBCs makes him immunosuppressed, so use good infection control procedures.
Platelet transfusion is usually considered in concert with a hematologist, but with bleeding complications and a plt count below 25K, nobody will fault you for doing it.
This guy was dangerously anemic, but showed no alteration in his vital signs. His pallor was the only clue to his anemia. Young healthy patients can mask really horrible problems by compensating well.
Obtain an EKG in suspected severe anemia. Any indication of strain or ischemia should prompt immediate transfusion.
Beware the petechial rash. Consider things like viral infection, meningococcus, septic emboli from endocarditis, idiopathic thrombocytopenia purpura, vasculitis like kawasaki's disease (usually young children), henoch-schoenlein purpura, Rocky Mountain Spotted Fever, leukemia, and other really bad things.
Sometimes, bad stuff happens to good people for no reason at all. true

'zilla

Excellent learning points esp. on compensation. Reminds me of cases with high (as in 210+) systolic BP and the person was having no problem at all.

Based on his symptoms (and assuming a busy ED), I would not have considered neuro consult at all. What were you trying to rule out, Doczilla?

Thanks for the education