study_ing
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diagnostic test for CLL?
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| study_ing
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any guesses?
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| tolito
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characteristic smear cells on peripheral blood smear?
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| tolito
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i rephrase
peripheral blood smear showing lymphocytosis and characteristic smear cells. CD 19 pos cells.
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| study_ing
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ok so we got a pt with smudge cels on tyhe smear..what next?
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| frank100
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no test should be called "the most accurate here", because only history and labs combined give you the definitive diagnosis:
age: normally old people
signs and symptoms: beggining from a mild fatigue, and ending with infiltration of reticuloendothelial system (splenomegaly, hepatomegaly, etc...)
*the typical here is when they give you an old guy who´s CBC comes with thousands of white cells (specially lymphicytes). "SMUDGE CELL" is the typical buzzword, but you better pay attention to clinical presentation and age.
there are markers associated, such as CD19, but not very important
hope it helps
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| study_ing
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in a pt with smudge cells, what do u choose to do?
a bone marrow
LN biopsy
cytogenetic analysis
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| frank100
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once you have a HUGE suspicion, then you can send, quantitative immuneglobulin levels, perform a bone marrow biopsy, guided radiology studies (CT if abodominal mass, chest CT, if lymphademopathy then biopsy), everything from now on points towards staging, because the best next step is to choose appropriate treatment.
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| study_ing
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ok this is what struck me by surprise..
the answer amongst these 3 was LN biopsy.
and apparently bon marrow biopsy is useful for diagnosis of MYELOID disorders.
it is not a useful tool for the diagnosis of CLL!
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| tolito
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i just remember the difference between these 2 by saying lymph node for lymphocytic, bone marrow for myeloid.
in any case, the presentation for CLL is lymph node enlargements.
thanks for the correction....smudge cells.
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| study_ing
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and i was one of those who wud biopsy anyone with a leukemia!!
step 2 is such a blessing actually--esp for the patients 
hopefully we'll be splendid doctors by the end of it
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