new_n_lost
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A 59 year old man complains of fatigue and weakness,abdominal fullness and discomfort in his upper left abdominal quadrant. On physical examination, he is found to have a low grade fever, splenomegaly and mild hepatomegaly. Laboratory tests are done, including a CBC with differential. He is found to be anemic and thrombocytopenic. His white blood count is 4,000/cu mm. His blood smear shows an unusual cell with cytoplasm projections. These cells are positive for acid phosphatase and resistant to tartaric acid. No Auer rods are visualized. He is negative for Philadelphia chromosome. A bone marrow aspiration was attempted, but no specimen was obtained.
Which of the following is most likely?
a) acute lymphoblastic leukemia
b) acute myelogenous leukemia
c) chronic lymphoblastic leukemia
d) chronic myelogenous leukemia
e) hairy cell leukemia
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| new_n_lost
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| new_n_lost
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Answer E hairy cell leukemia
Hairy cell leukemia has distinctive cells present in the peripheral blood smear, called 'hairy cells'. This patient is the appropriate age for the onset of hairy cell leukemia. Anemia is a common finding, as is splenomegaly. A positive tartrate resistant acid phosphatase reaction is also consistent with hairy cell leukemia. The majority of patients with hairy cell leukemia present with pancytopenia, as is the case here.
In acute lymphoblastic leukemia (choice a) there would be numerous blast cells in the peripheral smear. ALL tends to occur in children with an average age of 4 (however, it can occur in adults).
In acute myelogenous leukemia (choice b) there would be numerous blast cells in the peripheral smear. AML tends to strike adults. The presence of Auer rods indicates AML.
In chronic lymphocytic leukemia (choice c) there would be a lymphocytosis. The lymphocytes will be mature looking cells. CLL occurs in older people.
The laboratory findings in chronic myelogenous leukemia (choice d) would show an elevated granulocytic count. The <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />Philadelphia chromosome is positive in the vast majority (90-95%) of patients with chronic myelogenous leukemia.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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