#MedStudentTwitter might find it useful. Some common case scenarios !!
Case 1
72, male, on routine CBC is found to have ⬆️ WBC count. Asymptomatic.
CBC: 12.2 / 77k / 215k
Lympho: 88%
No HSmegaly
This is most likely CLL.
Q now is, does he need rx?
Case 1
72, male, on routine CBC is found to have ⬆️ WBC count. Asymptomatic.
CBC: 12.2 / 77k / 215k
Lympho: 88%
No HSmegaly
This is most likely CLL.
Q now is, does he need rx?
The answer in this case would be NO.
Always think about benefit vs risk when u want to start Rx. CLL many a times may not need rx at all.
Important learning point➡️DON'T get ALARMED by a ⬆️TLC.
Always think about benefit vs risk when u want to start Rx. CLL many a times may not need rx at all.
Important learning point➡️DON'T get ALARMED by a ⬆️TLC.
Case 2
42, male, p/w fatigue and dragging abdominal pain, ⬇️appetite x 2months
CBC: 12.6/356k/405k
Baso: 4%
Spleen 4cm BCM
This is most likely CML.
DX is confirmed by FISH for 9;22 or BCR-ABL PCR
MC transcript type: p210
42, male, p/w fatigue and dragging abdominal pain, ⬇️appetite x 2months
CBC: 12.6/356k/405k
Baso: 4%
Spleen 4cm BCM
This is most likely CML.
DX is confirmed by FISH for 9;22 or BCR-ABL PCR
MC transcript type: p210
Treatment ➡️ TKIs
We have 5 TKIs available:
Imatinib (1st gen)
Nilotinib(2nd)
Dasatinib(2nd)
Bosutinib(2nd)
Ponatinib(3rd)
Most of the times we start with imatinib.
3-6 monthly BCR-ABL quantitative PCR to monitor response. Certain milestones have to be met, more on that later.
We have 5 TKIs available:
Imatinib (1st gen)
Nilotinib(2nd)
Dasatinib(2nd)
Bosutinib(2nd)
Ponatinib(3rd)
Most of the times we start with imatinib.
3-6 monthly BCR-ABL quantitative PCR to monitor response. Certain milestones have to be met, more on that later.
Case 3
36, male, no co-morbidities.
P/w➡️image 1. Duration: 10days
CBC: 11/5600/44k
This could be a lot of things(not only ITP)
Order some more tests when in doubt.
INR 1.8
aPTT 84
Fibrinogen 88
Creat 0.8 / Bil 0.6
36, male, no co-morbidities.
P/w➡️image 1. Duration: 10days
CBC: 11/5600/44k
This could be a lot of things(not only ITP)
Order some more tests when in doubt.
INR 1.8
aPTT 84
Fibrinogen 88
Creat 0.8 / Bil 0.6
New onset coagulopathy + TCP in an otherwise healthy adult.
D/D are infectious causes, malignancy, sepsis.
Learning point➡️ Not all Thrombocytopenia is ITP.
Smear of this pt in image.
Large cells with Auer rods(faggot cells)➡️Acute promyelocytic leukemia.
D/D are infectious causes, malignancy, sepsis.
Learning point➡️ Not all Thrombocytopenia is ITP.
Smear of this pt in image.
Large cells with Auer rods(faggot cells)➡️Acute promyelocytic leukemia.
It's a Hematological emergency.
Can be salvaged with immediate initiation of ATRA. Coagulopathy needs aggressive correction. Best to refer to a Hematologist urgently !!
Learning point➡️ know when to refer !!
Can be salvaged with immediate initiation of ATRA. Coagulopathy needs aggressive correction. Best to refer to a Hematologist urgently !!
Learning point➡️ know when to refer !!
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