This is a 40 years old Indian lady who was admitted with complains of abdominal swelling for the past 6 months. She also has loss of appetite. Clinically she has hepatosplenomegaly with a spleen of 10 cm below the L costal margin and a liver of 5 cm below the R costal margin at R midclavicular line.
A peripheral blood film done shown as above.
Question 1 :
What does the PBF show ?
What further investigations would you do ?
What are the other causes of massive splenomegaly ?
What is the definitive way to find the diagnosis ?
What is the treatment ?
2 comments:
I'll give it a try:)
1. The PBF shows a complete spectrum of myeloid precursors and segmented neutrophils.Chronic Myeloid Leukaemia.
2. (a)FBC
(b)bone marrow aspiration
(c)urea and electrolytes
(d)cytogenetic studies- conventional or FISH
(e)Neutrophil alkaline phosphatase
3. myelofibrosis, malaria, kala-azar, Gaucher's disease
4. cytogenetic studies can show the presence of Ph1 chromosome, which is the reciprocal translocation between chromosome 9 and 22.
5. (a)Imatinib mesylate(Gleevec),a specific tyrosine kinase inhibitor.
(b)alfa-interferon
(c)Hydroxyurea,inhibitor of deoxynucleotide synthesis
(d)Busulfan
(e)Leukapheresis with chemotherapy
(f)Bone marrow transplant- considered in young patients with matching donors.
Yes, the film shows a leucoerythroblastic picture. Imatinib is the drug of choice, the others are nothing compare to it. However the only problem is cost. We are rather fortunate to be still under the GIPAP program for 3rd world countries.
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