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Old 08-21-2012
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A 55 year old woman comes with complaints of episodes of night sweats and fever,for last 6 weeks.She denies any cough or other respiaratory complaints .She has lost 20 lb(9kg) and does not feel like eating anything .She denies smoking or alcohol use.Her brother was recently diagnosed with polycythemia vera .Physical exam reveals pallor and splenomegaly.Chest Xray is normal.
Blood work is ordered and results are :
Wbc 66,100/cmm
hemoglobin 8.70
hematocrit 30%
platelets 610,000/cmm

the leukocyte differential smear was
Promyelocyte 1%
myelocyte 8%
Metamyelocyte 15%
Bands 35%
Segmanted neutrophils 25%
Lymphocytes 14%
Monocytes 2%
Further tests are ordered.Which one of the following is expected in this patient?

A. Increased bone marrow iron
B. Absence of measurable erythrocyte in urine
C. Presence of auer rods
D. Decreased leukocye alkaline phosphate
E. Presence of tartarate resistant acid phosphate
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Old 08-21-2012
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ans D .........low LAP ....... pt has CML ......
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Old 08-21-2012
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But my doubt is ,since the blasts are >20% , wouldn't this make AML as the diagnosis
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Quote:
Originally Posted by step_enhancer View Post
But my doubt is ,since the blasts are >20% , wouldn't this make AML as the diagnosis

It has band cells not blast cells ...........band cells are a stage just before forming a developed granulocyte . see these stages

http://en.wikipedia.org/wiki/Granulopoiesis

you probably mixed them up ........
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D. Decreased leukocye alkaline phosphate

decreased LAP; to differentiate from leukemoid reaction

Age, of ALL, AML, CML, CLL.... it is CML
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Old 08-21-2012
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ohh damn ...yes u right its band not blast

then what differentiates CML from AML in this question
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Quote:
Originally Posted by step_enhancer View Post
ohh damn ...yes u right its band not blast

then what differentiates CML from AML in this question

as plastic surgeon said the age ......

CML 30 to 60 yrs and less blast cells

AML after 60 and more blast cells ( blast crisis )
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Old 08-21-2012
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D. Decreased leukocye alkaline phosphate
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Old 08-21-2012
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Quote:
Originally Posted by step_enhancer View Post
ohh damn ...yes u right its band not blast

then what differentiates CML from AML in this question
here are the clues int he question,

1, pt had brother with PRV. rember PRV, CML and Myelofibrosis and essential thrombocythemia are JAk2 which can be inherited

2. Pt has S/S same as PRV which is PRURITIS!!

3. Pt has Increased Neutrophils - Classic for CML! (CLL has increased Lymphocytes)

4. Also AML has anemia, thrombocytopenia and leukpenia mostly!! wheres as the chronic leukemias hav Increased WBCs.

5. as for age, from what i remeber form goljan step 1, AML agegropu is bw 15-39yrs, CML is 30-59yrs and CLL is 60+. and ofc ALL 0-14 yrs
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Old 08-21-2012
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Quote:
Originally Posted by shyangel18 View Post
here are the clues int he question,

1, pt had brother with PRV. rember PRV, CML and Myelofibrosis and essential thrombocythemia are JAk2 which can be inherited

2. Pt has S/S same as PRV which is PRURITIS!!

3. Pt has Increased Neutrophils - Classic for CML! (CLL has increased Lymphocytes)

4. Also AML has anemia, thrombocytopenia and leukpenia mostly!! wheres as the chronic leukemias hav Increased WBCs.

5. as for age, from what i remeber form goljan step 1, AML agegropu is bw 15-39yrs, CML is 30-59yrs and CLL is 60+. and ofc ALL 0-14 yrs
Very nice ......thanks a ton !
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