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Old 11-01-2012
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Arrow Gyrus Daily Questions; Internal Medicine #63

A 54 year old man comes to the emergency department for shortness of breath, blurry vision , confusion, and priapism. His WBC count is found to be 22500/uL the cells are predominately neutrophils with about 4 % blasts.

What is the most appropriate next step in the management of this case ?

a. Leukapheresis
b. BCR- ABL testing
c. Bone marrow biopsy
d. Bone marrow transplant
c. Consult hematology/Oncology
f. Flow cytometry
h. Hydroxyurea
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Should be A Leukapheresis as we need to take care of his symptoms first. Then we can progress to BCR-ABL testing
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A

If we dont act now he will lose both his penis and his brains
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a. Leukapheresis

followed by h. Hydroxyurea
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Old 11-02-2012
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The correct answer is (A ) Leukapheresis.

In acute leukostasis reaction,It is more important to remove the excessive white cells from the blood than to establish a specific diagnosis. Specific testing is not as important as treatment.No matter what the etiology, you still have to take the cells off.The symptoms ate caused by blocking the delivered of oxygen to the tissue cecasie the cells cannot get to the tissue. Afterwards you can establish a specific diagnosis.
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