Mohammed is Tired

Mohammed is Tired

1. WBCs

   • Non Neoplastic
     • Leukocytosis
       • Neutrophilic leukocytosis
       • Lymphocytosis
       • Eosiniophilia
       • Monocytosis
       • Leukaemoid Reaction
         • reactive and excessive leucocytosis
   • Neoplastic
     • Lymphoid Neoplasms
     • Myeloid neoplasms
     • Histiocytic neoplasms
   • Leukemia Vs Lymphoma
     • Lymphoma
   • Leukemia
     • Acute myeloblastic leukemia(AML)
     • Chronic myelocytic leukemia (CML)
     • Chronic lymphocytic leukemia (CLL)

2. History Taking

   • Anemia symptoms
     • Fatigue, weakness
     • Blood in stools
     • Easy bruising
     • Heavy menstruation
     • dyspnea
   • Lymphoid symptoms /signs
     • Infections
     • Swelling of lymph nodes
     • Tender lymph nodes
     • Order of nodal enlargement
   • Past medical, surgical history
     • Frequent infections
     • Bleeding disorders
     • Radiotherapy
     • Recent trauma causing bleeding
     • Surgery to GI
     • Transplant surgery
   • Drug history
     • Drug currently taking
     • OTC’s especially NSAIDs
     • Anticoagulant therapy
     • Vitamins, supplements especially Iron, B12
     • Allergies
     • Drug allergies
   • Family history
     • Same condition in a family member
     • Hemophilia, von willebrand’s
     • Leukemia (Philadelphia chromosome)
     • Sickle cell anemia
     • Thalassemia

3. Investigations

   • CBC and Blood film
     • Determine the Blast count
     • To differ the type of Blast: Myeloblast or Lymphobast (AML or ALL?)
     • To make a total & differential WBC count
     • To study the RBC count and morphology
   • Confirming
     • FISH
       • used to detect the BCR-ABL gene and to monitor the disease during treatment
     • PCR
       • can find the BCR-ABL fusion gene and other molecular abnormalities
       • Is more sensitive than FISH
       • can be used to monitor the expression quantitively
     • Bone marrow aspiration
       • Removes a sample of the fluid with a needle.
     • Bone marrow biopsy
       • Removal of a small amount of solid tissue using a needle

4. Chronic Myeloid Leukemia

   • Clonal proliferation of granulocytic precursor cells.
   • Stages
     • Chronic Stage
     • Accelerated Stage
     • Blastic Stage
   • Morphology
     • Marked leukocytosis , neutrophils at various stages of development
   • Risk factors
   • Philadelphia Chromosome
   • Management
     • Pharmacological
       • Tyrosine kinase inhibitors
         • Imatinib Mesylate
     • Hematopoietic stem cell transplantation
       • Autologous
       • Allogeneic
       • Umbilical Cord
     • Other Treatment
       • Chemotherapy
       • Interferon Therapy
       • Radiation Therapy

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