“A 22-year-old female primigravida at 26 weeks gestation presented to the emergency department with a 5-day history of fever, fatigue, bruising along with nose and gum bleeding. Laboratory investigation revealed a white blood cell count of 76.2 × 103/mm3, hemoglobin 3.6 (g/dl) and platelets 6 × 103/µl. A bone marrow biopsy revealed precursor B-cell ALL, 95% blasts with BCR-ABL rearrangement (Philadelphia chromosome) by fluorescent in situ hybridization (FISH) in 82% of cells and reverse transcriptase-polymerase chain reaction (RT-PCR) detecting BCR-ABL breakpoint fusion.”

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1. Discuss the pathophysiological changes that occur with acute lymphoblastic leukemia specifically addressing laboratory values with rationales.

2. What ethical and legal issues does this specific case pose since this female is pregnant?

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