Ayesha Arif, Arif Tajammul.
Transient myeloproliferative disorder in an infant with trisomy 21.
Pak Paed J Jan ;21(2):101-2.

A baby boy weighing 2.4 kg presented at the neonatal unit with yellowish discoloration of the body and excessive cry since birth. The baby was born by spontaneous vaginal delivers to a twenty five year old primigravida at thirty six weeks gestation with insignificant ante-natal and post-natal events. Examination revealed features of Down syndrome. The neonate was jaundiced but active. Systemic examination revealed firm hepatosplenomegaly (three centimeters). A ventricular septal defect (VSD) murmur audible at the left lower parasternal area. Laboratory investigations showed unconjugated hyperbilirubinacmia, total leukocyte count (TLC) in a range of 31.6 to 94x 10(9)/l The differential showed lymphocytosis (88%), of these 77% were blast cells. The platelet count was within normal limits and hemoglobin ranged from 12 to 17.3 dl. Bone marrow study suggested a diagnosis of acute lymphoblastic leukemia. Routine neonatal care was offered and he was discharged in a satisfactory condition. Follow up TLC carried out one month later showed 30 x 10(9)/l leukocytes with no blast cells. The count reverted back to normal at three months of age (TLC 12x10(9)1 with no blast cells). The baby weighed 3.9 kg and was gaining weight.

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