One of the most common Oncology e-consults I get is a post-menopausal woman with sweats, no lymphadenopathy, a completely normal CBC, RBC indices, & diff where the concerned primary is asking about the utility of a bone marrow biopsy to evaluate for an occult heme malignancy.
In first year of fellowship, one time on Heme consults, on my weekend off, the team gave ATRA & did a marrow on a patient with nary a circulating blast or promyelocyte (but gorgeous babesia rings) on the peripheral smear.
He did not in fact have occult APML, just Babesiosis.
He did not in fact have occult APML, just Babesiosis.
I have seen a few occult Heme malignancies - a T-ALL presenting as parotitis for example; some indolent lymphomas presenting with paraneoplastic autoimmune manifestations
But, most have been stunningly obvious - circulating blasts, cytopenia(s), obvious nodes or splenomegaly.
But, most have been stunningly obvious - circulating blasts, cytopenia(s), obvious nodes or splenomegaly.
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