We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
On My Mind |

Three’s Company

James A. Feinstein, MD
Arch Pediatr Adolesc Med. 2009;163(9):782. doi:10.1001/archpediatrics.2009.147.
Text Size: A A A
Published online


Two. Nine. Forty-three.

I winced as the numbers streamed through my consciousness.

Three cell lines down.

Twenty-two percent blasts.

Suddenly the small emergency department examining room felt suffocating, the parents staring at me while I reviewed the sheet of laboratory values they had brought with them. They waited.

The 11-year-old girl's parents had taken her to the dentist earlier that week for a root canal that had morphed into a relentless oral infection; on reexamination, prominent lymph nodes had prompted her dentist to draw a complete blood cell count in search of an infection diagnosis. He had called the family and directed them to the emergency department as soon as the outpatient laboratory had processed her results. When she presented to the emergency department, her parents believed that she had an overwhelming bacterial infection necessitating intravenous antibiotics. They did not yet know that her age alone placed her in a high-risk category for leukemia.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Collections