O. M. is a 6-year-old child at a freestanding emergency room.Per the mother, O.M. is complaining of being tired, sleeping atnight with several naps in the day, and her appetite is decreasing.The mother reports an uneventful pregnancy and delivery; O.M. hasmet her milestones, and immunizations are up to date. Her parentsand younger brother are healthy. Paternal grandfather died ofcolorectal cancer in his 70s. She has no medical history and has nomedication.  

All vital signs are normal except for an elevated heart rate andshe is minimally underweight.

All assessment findings are normal with the exception of:

·        Skin pale butwarm and dry

·        Bruising overthe buttocks and left flank

·        Noted oralmucous membranes with petechiae

·         Mildenlarged, cervical, submaxillary, inguinal nodes

·        Presence ofhepatosplenomegaly

Blood work:

Hemoglobin decreased

Hematocrit decreased

RBC count decreased

WBC 13,100/mm3

Neutrophils 58%

WBC differential identifies 11% are blast cells

Platelet count 30,000/mm3

PT/PTT normal

Later results:

Bone marrow aspirate: 94% blast cells, 3% erythroblasts, 3% allother cells.

Reverse Transcriptase - Polymerase Chain Reaction: positiveTEL-AMI fusion gene. No other abnormality.

Chest x-ray: Normal

Lumbar puncture: Cerebral spinal fluid normal

Immunology: positive for cytoplasmic µ heavy chain protein

1. Explain the genetic implications and risk factors in thedevelopment of Acute Lymphoblastic leukemia
2. Explain the pathophysiologic or physiologic response leading toO.M. being tired, sleepy, and decreased appetite.
3. What other patient information would you have wanted to have aclearer understanding of the patient?
4. Provide examples of chemical exposures, environmental hazards,or antigens that may lead to leukemia
5. What is the prevalence of childhood ALL?