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Malignancy Labs

Hematology

QuestionAnswer
P. vera lab data Positive JAK-2 (janus kinase) serum test (pos in 74-97% of pts). Radiolabeled RBC study. Low EPO. WBC 10-20, PLt possibly >1M. High B12, LAP, uric acid. Pseudohyperkalemia. Normal SaO2.
JAK-2 mutations may be associated with: Myelofibrosis. 50% of patients with essential thrombocytosis. 97% of patients with P vera
Multiple myeloma evaluation SPEP (M-spike); 24 hr urine (Bence-Jones pro); Serum viscosity (may req plasma pheresis); Metastatic bone survey (lytic lesions); BM bx (inc. cytogenetics for q13- chromosome abnormality); Beta-2 microglobulins
Part of eval for multiple myeloma (if elevated = very poor outcome) Beta-2 microglobulins
Dohle bodies blue patch near edge; PMN; infxn
Toxic gran purple/blue-black; PMN; severe infxn/toxic
Hyperseg 6or more/3% w/5 or more; PMN; megaloblastic anemia, B12-folate def
Vacuoles Monos/PMN; poss sepsis
LAP = leukocyte alkaline phosphatase; Low in CML; High in leukemoid reactions
Platelets in leukemias Increased (acute); normal (chronic)
Auer rods AML
Smudge cells CLL
Fried egg hairy cell
Hypercellular bone marrow with reticulin or collagen fibrosis myelofibrosis
Reed-Sternberg cells large cells with multiloculated or bilobed nuclei with halo around inclusion nucleoli; seen in Hodgkin Disease
NHL labs Anemia, high LDH and ESR. Test for HIV. CXR, CT of chest & A/P, LN bx, LP if CNS involvement
Test needed for dx of NHL LN bx (excisional LN bx is preferred)
ALL: anterior mediastinal mass on CXR is suggestive of: T-cell ALL
CML findings Median WBC = 170,000 at dx; splenomegaly; BM/PBS: Phil. Chr (bcr/abl fusion gene); FISH for bcr/abl (quantitative); RT-PCR for bcr/abl (qualitative); thrombocytopenia (30%)
Hemochromatosis labs High plasma iron (>200), transferrin saturation (70-100%), serum ferritin, LFTs, hepatic iron. Low TIBC. HFE gene mutation.
Gold standard for Hemochromatosis dx: Liver biopsy with parenchymal hemosiderin
Created by: Abarnard