What should a doctor do in such a case?
Initial workup:
• CBC with differential
• Peripheral smear (look for blasts)
• Reticulocyte count
• LDH & uric acid (high cell turnover)
• Coagulation profile (PT/INR, aPTT, fibrinogen)
• Renal & liver function tests
• Electrolytes
• Chest X-ray if mediastinal involvement suspected
Confirmatory tests:
• Bone marrow aspiration/biopsy
• Flow cytometry (immunophenotyping)
• Cytogenetics & molecular studies
Important:
Do not label these patients as simple gingivitis or viral illness without checking CBC if red flags are present:
• Pallor
• Fever
• Bruising/bleeding
• Lymphadenopathy
• Hepatosplenomegaly
• Bone pain
Early suspicion saves lives.