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  #1  
Old 12-20-2012
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Blood A 47-year-old man with leukemia

A 47-year-old man presents to his primary care physician complaining of fatigue for the past several months. A review of systems reveals that the man has had poor sleep due to sweating at night and has lost 4.5 kg (10 lb) recently, although he has not been trying to lose weight. In addition, he has been suffering from severe headaches and blurry vision recently. On examination, he is pale and thin, with multiple ecchymoses. Cardiac examination is significant for a II/VI systolic flow murmur. He has an enlarged spleen on abdominal examination.
Laboratory tests show:
WBC count 95,000/mm3
15% Blasts
15% Bands
47% Polymorphonuclear cells
7% Basophils
10% Lymphocytes
Hemoglobin 7.2 g/dL
Platelet count 90,000/mm3

Which of the following is the next best step in establishing a diagnosis?

(A) Coagulation studies
(B) Cytogenetic studies
(C) Detection of serum leukocyte alkaline phosphatase levels
(D) Iron studies
(E) No further studies are necessary for establishing the diagnosis
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  #2  
Old 12-20-2012
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(C) Detection of serum leukocyte alkaline phosphatase levels
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(B) Cytogenetic studies

since you would like to rule out or establish M3 subtype by doing FISH as the treatments differ from the rest of the AML.

Quote:
Because acute promyelocytic leukemia (APL) has the highest curability and requires a unique form of treatment, it is important to quickly establish or exclude the diagnosis of this subtype of leukemia. Fluorescent in situ hybridization performed on blood or bone marrow is often used for this purpose, as it readily identifies the chromosomal translocation (t[15;17]) that characterizes APL.[26]
Quote:
Leukocyte alkaline phosphatase (LAP) is found within white blood cells. White blood cell levels of LAP can help in the diagnosis of certain conditions.
  • Higher levels are seen in polycythemia vera (PV), essential thrombocytosis (ET), primary myelofibrosis (PM), and the leukemoid reaction.
  • Lower levels are found in chronic myelogenous leukemia[17] (CML), paroxysmal nocturnal hemoglobinuria (PNH) and acute myelogenous leukaemia (AML).
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Last edited by Novobiocin; 12-20-2012 at 05:50 PM.
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i think its cytogenic studies
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I also think B
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Suspecting AML.....so my answer is B.....
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  #7  
Old 12-21-2012
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I think its b......aml but i was also suspecting lad to exclude aml, cml, pnh(increased lad excludes this)
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Quote:
Originally Posted by Novobiocin View Post
(B) Cytogenetic studies

since you would like to rule out or establish M3 subtype by doing FISH as the treatments differ from the rest of the AML.
Quote:
Because acute promyelocytic leukemia (APL) has the highest curability and requires a unique form of treatment, it is important to quickly establish or exclude the diagnosis of this subtype of leukemia. Fluorescent in situ hybridization performed on blood or bone marrow is often used for this purpose, as it readily identifies the chromosomal translocation (t[15;17]) that characterizes APL.[26]
Quote:
Leukocyte alkaline phosphatase (LAP) is found within white blood cells. White blood cell levels of LAP can help in the diagnosis of certain conditions.
  • Higher levels are seen in polycythemia vera (PV), essential thrombocytosis (ET), primary myelofibrosis (PM), and the leukemoid reaction.
  • Lower levels are found in chronic myelogenous leukemia[17] (CML), paroxysmal nocturnal hemoglobinuria (PNH) and acute myelogenous leukaemia (AML)
.
Excellent
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