They revealed a decreasing concentration of hemoglobin, RBC and platelet count. Finally, blasts become present in the peripheral blood (Tab. I). These disorders have become a reason for starting the hematological diagnostics. In the bone marrow biopsy the image was monotone, with very high amount of cells in the bone marrow

matrix. 91.6% of cells were young, blastic, of medium size. Red blood cell aplasia, few granulocytes and megakariocytes. Metformin nmr In the cytochemical tests, PAS reaction was positive in 82% of blasts, POX reaction in blastach was negative. Based on the tumor cell immunophenotype – expression of markers: Td T+, CD19+, CD 22+, CD45+, cIgM+ patient was diagnosed with acute lymphoblastic leukemia pre-B ALL. Cytogenetic study ruled out the presence of unfavorable prognostic fusion genes: BCR\ABL and MLL\AF4. Based on Saracatinib solubility dmso the results the patient was stratified to the intermediate-risk group (IR) and started therapy according to the ALL IC 2002 Protocol. The time from initial presentation to final diagnosis was nine weeks. Currently the described girl is in good condition. Control bone marrow biopsy after completion of therapy shows the characteristics of haematologic remission, the results of the mielogram reveal 2.4% blasts. Typical clinical picture of hematologic proliferative disease in the form of pale skin and mucous membranes,

weakness, fever, DAPT chemical structure bruising, bleeding, bone pain, arthralgia, abdominal pain, or lymphadenopathy may mimic other diseases common in pediatrics [2]. Differential diagnosis of bone pain in children is very broad. Among the most common causes are: trauma, congenital defects, infections, rheumatologic diseases, but also malignancies. Alarming symptoms include acute, increasing pain, restriction of movement, accompanying neurologic symptoms and ailments persisting despite antiinflammatory treatment [1, 3]. Findings reported in the literature and own observations indicate

that symptoms associated with the musculoskeletal system in patients with acute lymphoblastic leukemia are not uncommon [3, 4, 7]. Among the 25 patients diagnosed with ALL and treated in the Department of Hematology Children Clinical Hospital in Lublin during the last year, 11 (i.e. about 45%) reported such symptoms. Pain of long bones was the dominant one, with children complaining mostly of pain in the lower limbs and large joints, knee and hip pain. Back pain affected only one, currently presented patient. In most cases, pain was accompanied by fever. Such patients often pose a significant diagnostic problem for physicians. Frequently, they received a non-steroidal antiinflammatory drugs and antibiotics. Lack of clinical improvement and subsequent symptoms, including weakness, loss of appetite, and bruising on the skin led to blood tests, which often revealed a profound anemia, and severe thrombocytopenia.