On My Mind |

Three’s Company

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


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