L7 - Leukemia And Lymphoma Cases Flashcards
What is an absolute neutrophil count (ANC)?
WBC x (neutrophil % + band %)
Severe neutropenia is defined as an ANC of what value?
<500
Empiric coverage is targeted for which organism first for neutropenic fever?
Gram negative organism (pseudomonas)
What is the 1st line of Abx for pseudomonas coverage?
Cefepime, piperacillin-taxobactam, meropenem, ceftazidine
Add MRSA coverage with vancomycin as well (if concern for line infection, PNA or soft tissue infection)
If a neutropenic fever persists 48 hours after onset of abx therapy what should be added?
Fungal coverage with amphotericin B and voriconazole
When should the bone marrow be rechecked for AML pts on chemo?
Recheck after 2 weeks
What is required prior to giving chemo to AML pts?
Central line placement
What is a common infection that can occur from a central line??
Fungal infection (most commonly candida)
Can be tested with a silver stain
Central cath will need to be replaced
What is induction chemo?
Initial chemo to induce a remission
What is consolidation chemo?
Intensifying chemo to make sure no cancer cells are left in the body
What is maintenance chemo?
For some cancers longer term therapy to maintain the remission and prevent relapse
A low LAP score is seen with what diagnosis?
CML
What is a LAP score?
Positive staining is seen in reactive conditions —> leukemoid reaction
Absent staining indicates an abnormal myelocyte population —> neoplasm
What are common ways to test for a Philadelphia chromosome?
Karyotype analysis (burdensome and can be subjective)
FISH
BCR-Abl PCR
What test is the most sensitive for testing the Philadelphia chromosome?
Amplification PCR
What are the stages of CML progression?
Chronic phase (<10% blasts)
Accelerated phase (10-19% circulating blasts) -thrombocytopenia and basophilia
Blastic phase (>20% blasts) -blast crisis
BCR-ABL increases with each progression
What are the three biopsy types?
Fine needle aspiration
Needle biopsy
Excision/excisional biopsy
What is a fine need aspiration?
Liquid sample for metastatic cells or flow cytometry
Worst type of biopsy
Will never be a test/board answer
What is flow cytometry?
Assessing the clonal nature of cells
What is a needle biopsy?
Solid core of tissue
Evaluation for metastatic cells and flow cytometry
What is excision/excisional biopsy?
Best way to diagnose lymphoma
Only way to diagnose Hodgkin lymphoma
