[Stamp]:
Ukraine
Chernivtsy Oblast Council
Department of Health Care
Public Medical Institution
OBLAST PEDIATRIC CLINICAL HOSPITAL
Code 02009548
207-A Ruska Str.
Oblast Pediatric Clinical Hospital of Chernivtsi city
207-A Ruska Str., 58023, Chernivtsi
Tel.: (03732) 6-70-83, 6-70-89
Tel. 67078
Cardiooncohematological department
“___”___________20__
Extract from case history No 1687
Kremenetska Nadiya Ivanivna,
Date of birth – 26.01.2008, who resides at Dobrynivtsi village of Zastavnivsky region
Diagnosis: Superearly complex recurrence of acute lymphoblastic leukaemia, common, L1, high risk group.
The diagnosis has been confirmed in reference laboratory of “OHMATDYT” Ukrainian Specialized Pediatric Hospital (USPH).
The patient was undergoing treatment in “OHMATDYT” USPH from 29.08.2008 till 20.02.2009, where intensive chemotherapy according to the protocol INTERFANT-99 has been accomplished in full.
The patient was undergoing treatment on an inpatient basis in cardiooncohematological department of Oblast Pediatric Clinical Hospital No 1 from 22.06.09 till 17.08.09. Complaints during the admission: headaches, irritability; the patient has been admitted for realization of a supportive treatment course.
Objective data:
Skin and visible mucous tunics are pale pink, clean, with no hemorrhages. Lymph nodes are not enlarged. The thyroid gland is not palpable.
The pharynx is without peculiarities. Percussion findings: attenuation of percussion sound on the left.
Harsh breathing without crepitations is detected over the lungs. Cardiac borders are not displaced. Cardiac sounds are rhythmic and clear.
The abdomen is soft, not painful, not enlarged. Liver +1 cm from costal arch, spleen +0.5 cm from costal arch, painful.
Urinalysis – no pathological data are revealed.
|
Data
|
Erythr.
|
Hb
|
Globular value
|
Leuko-cytes
|
Stab neutron-phils
|
Segmented neutrophils
|
Eosino-plils
|
Lympho-cytes
|
Mono-cytes
|
ESR
|
Plate-lets
|
|
23.06
|
3.9
|
122
|
0.9
|
3.3
|
4
|
12
|
3
|
76
|
5
|
9
|
260
|
|
13.07
|
2.7
|
80
|
0.88
|
1.4
|
1
|
7
|
0
|
90
|
2
|
9
|
250
|
|
31.07
|
112
|
3.6
|
0.9
|
4.8
|
17
|
49
|
0
|
27
|
7
|
10
|
260
|
|
13.08
|
80
|
2.7
|
0.88
|
4.2
|
8
|
80
|
1
|
10
|
1
|
7
|
150
|
Myelogram dated 24.06.09: blast cell content is 60% (recurrence of acute lymphoblastic leukaemia has been confirmed in reference laboratory of “OHMATDYT” USPH).
Myelogram dated 14.07.09 (15th day) - blast cell content is 2%.
Biochemical monitoring is within the norm limits.
Ultrasonic diagnostics of heart dated 26.06.09: myocardial contractility is 65%.
Liquorogram (microscopic examination of stained preparation) dated 22.06.09: cytosis - 1144/3, protein – 0.33%; blast cells content – 40%.
Liquorogram dated 14.07.09 – a variant of norm.
ECG results are within the age-specific norm limits.
TREATMENT:
On 24.06.2009 the child has been exposed to anti-relapse block of supportive chemotherapy (ІІ-Ida), calculated per body area 0.44 m2 (see the protocol).
Presently the child is in remission.
The child requires consultation of Republican Pediatric Hematologist, associate professor Donskaya S.B. in order to choose the further treatment tactics and to take a decision concerning bone marrow transplantation.
Recommendations:
- “D” observation of hematologist
Following the recommendation of the joint group, currently, the child undergoes 2nd protocol BFM-ALLIC-2002 (the 10th day).
Department head
Pediatric hematologist [Signature] M.G. Gnatyuk
[Seal] [Physician’s seal] | 
