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Old 08-15-2011
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Blood Fatigue and Basophilic CD20 Cells!

A 64-year-old female with several months of fatigue is found to have a leukocyte count of 68,000 cells/mm3. A peripheral smear demonstrates a predominance of mature-appearing, basophilic cells with minimal cytoplasm. Flow cytometry reveals that these cells express CD20. Which additional laboratory findings do you expect?
A. Elevated leukocyte alkaline phosphatase activity
B. Excellent response to treatment with 2-chlorodeoxyadenosine
C. Expression of a fusion gene with tyrosine kinase activity
D. Expression of tartrate-resistant acid phosphatase
E. None of the above
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Old 08-15-2011
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I would say NONE OF THE ABOVE>
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Old 08-15-2011
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Quote:
Originally Posted by ricko335 View Post
A 64-year-old female with several months of fatigue is found to have a leukocyte count of 68,000 cells/mm3. A peripheral smear demonstrates a predominance of mature-appearing, basophilic cells with minimal cytoplasm. Flow cytometry reveals that these cells express CD20. Which additional laboratory findings do you expect?
A. Elevated leukocyte alkaline phosphatase activity
B. Excellent response to treatment with 2-chlorodeoxyadenosine
C. Expression of a fusion gene with tyrosine kinase activity
D. Expression of tartrate-resistant acid phosphatase
E. None of the above
Let's see...
A. Alkaline phosphatase is not related to B cells (polycythemia vera, essential thrombocytosis, primary myelofibrosis)
B. Excellent response to 2-chlorodeoxyadenosine (cladribine) is hairy cell leukemia. that could be (hairy cell leukemia has cd20)
C. Fusion gene has to be BCR-ABL which is seen frequently in CML (would not have CD20 unless in blastic crisis maybe). Also this fusion gene (product of Ph chromosome) can be seen in some cases of ALL, in that case it might have cd20 although not the most likely thing in the world.
D. TRAP is again hairy cell
So I guess I'm between B and D

Last edited by patient doctor; 08-16-2011 at 05:03 AM.
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Old 08-15-2011
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I guess C) CML
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Old 08-15-2011
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I am with CML too
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Old 08-16-2011
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Quote:
Originally Posted by ricko335 View Post
a 64-year-old female with several months of fatigue is found to have a leukocyte count of 68,000 cells/mm3. A peripheral smear demonstrates a predominance of mature-appearing, basophilic cells with minimal cytoplasm. Flow cytometry reveals that these cells express cd20. Which additional laboratory findings do you expect?
A. Elevated leukocyte alkaline phosphatase activity
b. Excellent response to treatment with 2-chlorodeoxyadenosine
c. Expression of a fusion gene with tyrosine kinase activity
d. Expression of tartrate-resistant acid phosphatase
e. None of the above
cccccccccccccc?
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Old 08-16-2011
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got d diagnosis but look at d features

The correct answer is E.
This patient is older, has significant leukocytosis, and has been symptomatic for months. These findings suggest a chronic leukemia. CLL is more likely because of the description of the peripheral smear: basophilic cells with minimal cytoplasm suggest lymphocytes, and the expression of CD20 confirms this. None of the answer choices are expected findings in CLL.

A fusion gene with tyrosine kinase activity is found in CML (bcr-abl). ↑ leukocyte alkaline phosphatase activity is seen in leukemoid reactions. Expression of TRAP and a good response to 2-chlorodeoxyadenosine are both features of hairy-cell leukemia, which, while a chronic leukemoid leukemia, usually affects middle-aged men and demonstrates hair-like, filamentous projections on peripheral smea
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Old 08-16-2011
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see no thinking required, its none of the above
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