Question

18-year-old male with hepatosplenomegaly, Hb 7 gm percent, LN+, WBC 50K, platelets 30, petechiae, purpura, and fatigue: what is the most appropriate management?

• A. Cytarabine + Iso?
• B. IVIG x 2 days
• C. Prednisolone + Vinblastine
• D. Radiotherapy to LN

Hint:

In cases of hematological malignancy like lymphoma or leukemia, steroids and chemotherapy (like vinblastine) are often used as first-line treatments.

Answer 1

The Correct Option is C

An 18-year-old male presents with symptoms indicating a blood or bone marrow disorder: hepatosplenomegaly (enlarged liver and spleen), anemia (Hb 7 gm%), lymphadenopathy (enlarged lymph nodes), high WBC count (50,000), low platelets (30,000), along with petechiae, purpura, and fatigue. These symptoms suggest a likely diagnosis of acute leukemia or a leukemia-like condition. Management should target the underlying pathology and address the specific clinical features presented.

Let's analyze the given management options for this clinical presentation:

• Cytarabine + Iso: Typically used in certain types of acute myeloid leukemia. However, without a definitive diagnosis of a specific subtype of leukemia, initiation with Cytarabine may not be the most appropriate initial management.
• IVIG x 2 days: Intravenous immunoglobulin (IVIG) is usually indicated for immune thrombocytopenic purpura (ITP) or other immune-mediated conditions but may not address the overall hematological issues like abnormal WBCs and hepatosplenomegaly indicative of leukemia.
• Prednisolone + Vinblastine: Prednisolone is a corticosteroid used to reduce inflammation and immune response, while Vinblastine is a chemotherapy agent effective against certain types of leukemia and lymphoma. This combination can target multiple pathological features observed in this case, such as reducing lymphadenopathy and addressing blood cell abnormalities.
• Radiotherapy to LN: Targeted radiotherapy is rarely used as an initial treatment in systemic hematological malignancies due to its limited scope and inability to address systemic disease features such as abnormal blood counts.

The most appropriate management for this clinical scenario, given the presentation and the need to immediately address the leukemic features, is the use of Prednisolone + Vinblastine. This option covers the broadest spectrum of the patient's symptoms by directly targeting both inflammation and the abnormal proliferation of blood cells seen in hematologic malignancies.