Hello Michele ,Dr. Brims is offline so I am answering your question. I am Dr. Arun and will be helping you today.His blood work does not indicate leukemia. Just because his fever has come back after two weeks and has persisted for 4 days, does not point to Leukemia unless there is a family history which needs an high index of suspicion. Otherwise just for these symptoms there are many other causes. To ascertain the cause he would need following investigations (some are repeat);1) Complete blood count2) Peripheral blood smear3) Comprehensive metabolic panel which includes liver and kidney function tests.4) Culture of blood and urine5) Chest x-ray6) Cultures of blood and urine.Usually these are good enough to diagnose the cause. If these are not conclusive and fever persists than further investigations as following may be ordered (not all would be done at once, but physical exam would dictate the selection of the work up);1) Obtain cultures for bacteria, mycobacteria, and fungi (blood, urine, stool, sputum, spinal fluid).2) Serologies for Brucellosis, CMV infection, amebiasis, toxoplasmosis, and chlamydial diseases.3) Serum protein electrophoresis (SPEP) is useful in diagnosing atrial myxoma, SLE flares, and lymphomas. 4) Serum ferritin levels are useful in cases of malignancies, SLE flare, and adult Still disease.5) Antinuclear antibody titers, rheumatologic factor, thyroxine level, and ESR, 6) High resolution CT scan of lung and CT scan of chest. 7) Ultrasound and CT scan of abdomen.8) Technetium bone scan9) Radionucleotide studies using gallium citrate or granulocytes labeled with indium for diagnosis of occult abscesses, neoplasms, or soft-tissue lymphomas.10) Positron emission tomography (PET) scanning has enhanced the detection of occult neoplasms, lymphomas, and vasculitides.11) Liver function tests and kidney function tests. 12) Adrenal function tests. 13) Peripheral blood smear14) Bone marrow cytology and biopsy.
Many patients with chronic leukemias are without any symptoms (asymptomatic). Leukemias usually present with
1) spleen enlargement (splenomegaly),
3) weight loss,
4) sense of non well being (malaise),
5) frequent infections,
6) bleeding (from nose or intestines or throat),
7) Clot formation (thrombosis), or
8) lymph node enlargement (lymphadenopathy). Please feel free for your follow up questions.
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