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Old 06-21-2012
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Question Lung infiltrates with high Leukocyte Alkaline Phosphatase!

A 37-year-old woman visits her physician because of a cough and fever of 1 week's duration. On physical examination, her temperature is 38.3C. She has diffuse crackles in all lung fields. A chest radiograph shows bilateral extensive infiltrates. CBC shows hemoglobin, 13.9 g/dL; hematocrit, 42%; MCV, 89 m3; platelet count, 210,000/mm3; and WBC count, 56,000/mm3 with 63% segmented neutrophils, 15% bands, 6% metamyelocytes, 3% myelocytes, 1% blasts, 8% lymphocytes, 2% monocytes, and 2% eosinophils. The peripheral blood leukocyte alkaline phosphatase score is increased. Which of the following is the most likely diagnosis?
(A) Chronic myelogenous leukemia
(B) Hairy cell leukemia
(C) Hodgkin lymphoma, lymphocyte depletion type
(D) Leukemoid reaction
(E) Acute lymphoblastic leukemia
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Old 06-21-2012
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Ddd....leukemoid reaction(+ve leucosyte alkaline phosphatase)
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Old 06-21-2012
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Quote:
Originally Posted by anomali View Post
(A) Chronic myelogenous leukemia
(B) Hairy cell leukemia
(C) Hodgkin lymphoma, lymphocyte depletion type
(D) Leukemoid reaction
(E) Acute lymphoblastic leukemia
LAP score is high........with PBF resembling leukemia
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Old 06-21-2012
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I would also go with leukemoid reaction ,,, thou I would be more confident if the left shift was more significant
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Old 06-21-2012
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Could anyone explain the LAP business? I always confuse it! It's supposed to be increased in leukemoid reaction, and decreased in CML?
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Old 06-21-2012
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Quote:
Originally Posted by dockhi View Post
Could anyone explain the LAP business? I always confuse it! It's supposed to be increased in leukemoid reaction, and decreased in CML?
Yeah there will be a positive lap in leukamoid reaction and negative in cml...But there are two other distinguishing features between leukamoid reaction and cml...cml will have increased basophils lr will not...and of course cml will have the 9;22 translocation and lr will not...read this from pathoma
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Old 06-21-2012
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leukemoid reaction.... key is the LAP score....
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Old 06-21-2012
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its D..........key word here is high LAP score
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