Labs
How do you calculate an absolute neutrophil count?
ANC = (Total WBC) x [(Neutrophil %) + (Bands%)] / 100
Why was methotrexate given to our patient?
To keep cancerous cells from getting into the CSF while performing the lumbar puncture
What is neutropenic fever?
Neutropenia (decreased concentrations of neutrophils in the blood) + fever
What caused our patient to become afebrile and develop hyperglycemia?
Steroid usage
What is a reticulocyte index and how do you calculate it?
A calculation that helps determine if anemia is due to inadequate RBC production or loss of RBCs
RI = [(Reticulocyte %) x (Patient's Hematocrit/Normal Hematocrit)] / Maturation Correction
What is the classification of vincristine?
Vinca alkaloids
How is acute lymphoblastic leukemia classified according to the 2016 WHO?
B-lymphoblastic leukemia/lymphoma or T-lymphoblastic leukemia/lymphoma
What are some of the psychosocial impacts of receiving a cancer diagnosis?
Deterioration of self-concept, body image disturbance, emotional distress, financial burden, social relationship troubles, isolation, spiritual and existential concerns, etc.
What is the difference between an automated and manual differential and what pros/cons exist?
Automated - Utilize a combination of various methods to quickly and accurately quantify blood cells. Pros - Faster, less expensive, more accurate/precise in quantifying blood cell measurements. Cons - Lacks specificity.
Manual - Allows for the quantification of blood cells AND the morphological characterization and differentiation of abnormal cells. Pros - allows for identification and morphological assessment of abnormal blood cells, allow for accurate diagnosis of blood cell disorders. Cons - More susceptible to error, takes longer.
What does doxorubicin act on and what enzyme does it inhibit?
Inserts itself within DNA base pairs causing breakage of DNA strands. Inhibits topoisomerase II.
How is tumor lysis syndrome treated?
Prophylactic treatment (allopurinol, rasburicase), IV fluids, electrolyte balance correction, and in severe cases, dialysis
What is the significance of the BCR-ABL mutation?
This mutation results in the constitutive activation of tyrosine kinase which results in continued cell proliferation, differentiation arrest, and resistance to cell death. Identification of the BCR-ABL mutation can help aid in diagnosis and subsequent treatment plans.
What is pancytopenia and what are some differential diagnoses?
A decrease in the number of cells of all cell lines in the peripheral blood (WBC, RBC, Platelets)
DDx: Bone marrow disorders, hematological disorders, infectious diseases, autoimmune disorders, nutritional deficiencies, medications
Describe the mechanism of action for cyclophosphamide.
First metabolized by liver enzymes (cytochrome P450), converted to hydroxycyclophosphamide, metabolized to aldophosphamide, aldophosphamide is cleaved to the active alkylating agent, metabolite forms cross-linkages within and between adjacent DNA strands at the guanine N7 position.
Compare and contrast ALL to CLL, CML, and AML (100 points each)
Correct answers will include discussion of cell lineage, diagnostic criteria, age of onset, symptoms, disease course, treatments, etc.
Describe the normal maturation of T-cells.
Originate in the bone marrow -> migrate to the thymus -> differentiate and produce TCRs (go from double negative to double positive) -> undergo positive/negative selection -> mature into function T-cells (CD4 helper cells or CD8 cytotoxic cells)