From the attached investigations, kindly explain the condition of the patient.

Question

Hi doctor,

The patient was admitted due to eight episodes of hematemesis, weight loss, and loss of appetite in the last six months. It was accompanied by bone pain, abdominal pain, abdominal distension, jaundice, vomiting, altered bowel habit, fever, shortness of breath, decreased urine output, or altered sensorium. Investigations the patient had are USG abdomen, UGI endoscopy, hemogram, liver function test, complete urine examination, differential WBC, smear study, microscopic examination, RT-PCR FOR BCR-ABL, and esophageal biopsy.

Answer 1

Hi,

Welcome to icliniq.com.

I had undergone the patient's reports (attachment removed to protect patient identity).

First of all, the patient has a tear in the esophageal mucosa because of which bleeding occurred. To prevent bleeding, I suggest a vasoconstrictor agent and adrenaline injection in the mucosa.
Barrett's esophagus was also positive in the histopathology report, but that is another issue for which regular screening was done.
Now, let me inform you your blood count was above 1.5 lakhs and the basophil is present in the smear, which usually does not see in the smear. So, CML was suspected (chronic myelogenous leukemia) and molecular testing for translocation 9.22 that is BCR-ABL gene was done, and it is positive.
So, it is a case of chronic myelogenous leukemia, a form of blood cancer. All your symptoms are because of that. You have to consult a nearby onco-hematologist for starting chemotherapy.
In this neoplasm, Imatinib mesylate tyrosine-kinase inhibitor drug must be prescribed along with other medication as per need like alpha interferon, Hydroxyurea, Busulfan, etc.
Without delay consult a nearby hematologist for examination and under his supervision start therapy.

Take care.