Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Chronic myeloid leukaemia with generalized lymphadenopathy – a high risk category(The Sri Lanka College of Haematologists, 2022) Prasanni, W.D.D.; Williams, H.S.A.; Costa, Y.J.; Dissanayake, T.Chronic myeloid leukaemia (CML) presenting with generalized lymphadenopathy is an uncommon manifestation of CML. Lymphadenopathy in these patients could be due to extramedullary involvement by myeloid cells with all stages of maturation, blast infiltration, co-existing lymphoproliferative disorder or reactive lymphadenopathy. We report a case of a 38-year-old male with CML in chronic phase and generalized lymphadenopathy at diagnosis. He transformed to blast crisis within 14 weeks of diagnosis despite tyrosine kinase inhibitor (TKI) therapy. This case indicates that CML patients with lymphadenopathy are at high risk of disease progression and early blast transformation and therefore candidates for aggressive treatment.Item A woman with unilateral thigh pain, moderate leukocytosis and extreme thrombocytosis (Case report 2)(The Sri Lanka College of Haematologists, 2019) Dilhani, M.N.; Jayaweera, W.M.N.M.; Williams, H.S.A.; Premawardhena, A.P.ABSTRACT: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm (MPN) of hematopoietic stem cells characterized by the presence of the Philadelphia (Ph) chromosome (t (9;22) (q34.1;qll.2), in which granulocytes are the major proliferative component. Atypical presentations of chronic phase CML reported include extreme thrombocytosis with or without leukocytosis, marked megakaryocytic proliferation or significant marrow fibrosis. We describe a middle-aged woman who presented with nonspecific leg pain and abnormal FBC parameters. Moderate leukocytosis (WBC 55 x 103/ pl), mild anemia and marked thrombocytosis (1,615 xl03/pl) were noted without clinical or laboratory features of ongoing infection or inflammation. Clinical examination revealed mild pallor only. A prominent spleen was noted ultrasonically (13.5 cm). A leucoerythroblastic blood picture was seen with moderate neutrophil leukocytosis, tear drop poikilocytes and one percent blast cells. No characteristic myelocytes and neutrophil peaks were present, and dysplasia was absent. Mild eosinophilia was observed however basophilia was absent. Platelets were markedly increased with anisocytosis. An underlying MPN suspected. JAK2V617 F mutation was absent and BCR-ABL (transcript type- b3a2) mutation detected. Her bone marrow biopsy revealed markedly hyper- cellular fragments with suppressed erythropoiesis, markedly hypercellular granulopoiesis (blasts <5%) with prominent eosinophil precursors. Megakaryocyte numbers were markedly increased with numerous micro megakaryocytes. The trephine biopsy displayed a few loose clusters of megakaryocytes. A marked background fibrosis noted (Grade (3/3). The diagnosis of chronic phase- CML was made. She was commenced on Imatinib 400mg daily and she achieved and maintained all the desired milestones since diagnosis.Item Splenic Syndrome in a young man at high altitude with undetected Sickle Cell Trait(Sage, 2018) Fernando, C.H.K.A.; Mendis, S.; Upasena, A.P.; Costa, Y.J.; Williams, H.S.A.; Moratuwagama, D.INTRODUCTION: Splenic syndrome is a rare presentation of sickle cell disease. It is important to rule out this possibility when an ethnically vulnerable patient presents with an acute abdominal symptoms in a background of precipitating events. CASE REPORT: A 26-year-old man who developed a severe abdominal pain at high altitude, found to have a tender splenomegaly. However, further inquiry revealed he is from an area where sickle cell disease is prevalent. Screening for sickle cell disease was positive. Radiological investigations confirmed a massive splenic infarction keeping with a diagnosis of splenic syndrome. Patient was managed conservatively. CONCLUSION: Sickle cell trait is considered a benign carrier state. However, rarely they can present with life-threatening conditions. Therefore, a high degree of clinical suspicion is required for early diagnosis of these specific entities to avoid increased morbidity and mortality of these patients.Item Iron deficiency anaemia in pregnancy: diagnosis, prevention and treatment(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Goonewardene, I.M.R.; Motha, M.B.C.; Williams, H.S.A.