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Malignancy Labs
Hematology
Question | Answer |
---|---|
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 |