"Mohammad’s Spleen is Palpable"

Anatomy and Palpation of the Spleen
1. spleen is a lymphatic organ located right above the stomach in the left hypochondriac region which corresponds to the ULQ.
2. Spleen Functions:
  1. Filters the blood from pathogens and debris
  2. Controls the level of blood cells
  3. Removes any old or damaged red blood cells.
3. Palpation of the spleen
  1. Place your right hand behind the patient's inferior rib cage to support it. Then, use your left hand to palpate along the left costal margin.
4. Causes of Splenomegaly
  1. Infections
    1. Mononucleosis
  2. Diseases affecting the liver
  3. Hemolytic anemia
  4. Blood cancers
    1. How to Differentiate between leukocytosis, leukemia and leukemoid reaction?
      1. Leukocytosis
        Increase total number of WBCs to > 11,000/mm3.
        Common cause is neutrophilia followed by lymphocytosis.
        Pathological (tissue damage, infections & worm infestations)
      2. Leukemoid reaction & leukemia
        Leukocytosis >50,000/microL when due to causes other than leukemia
        Characterized by a significant increase in early neutrophil precursors (myelocytes, metamyelocytes)
        Leukemia: Uncontrolled production of WBCs mainly caused by cancerous mutation.
        Leukemoid reaction
        Proliferation of all the normal myeloid elements is observed in the BM
        Classification of Leukemias
        According to the clinical course of the leukemia.
        According to their cell of origin in the hematopoiesis process.
        depending on which lineage is affected.
        FAB Classification of ALL
        What is Chronic Myeloid Leukemia?
        About 15% of leukemias in adults are CML
        Philadelphia chromosome
        Translocation between chromosome 9 and 22.
        sometimes found in acute lymphocytic leukemia.
        CML Phases
        Fatigue, weakness, night sweats
        Diagnosis
        Complete blood count (CBC)
        Bone marrow biopsy
        Bone marrow tissue sample
        Risk Factors for CML
        Age
        Gender
        Congenital disorders
        Chemical & drugs
        Pathogenesis of CML
        caused by a reciprocal translocation t(9;22),
        a piece of chromosome 9 containing the ABL1 oncogene is translocated to chromosome 22 and fused to the BCR gene
        BCR-ABL fusion gene to take place and for tyrosine kinase activity to become irregular.
        Investigations of CML
        CBC
        blood smear
        Bone marrow biopsy
        Hypercellularity - cells of myeloid cell line precursors
        Karyotypic analysis
        Fluorescent in situ hybridization FISH
        PCR: BCR-ABL-1 gene mapping
        Treatment of CML
        Imatnib (first line treatment)
        Stem cell transplant
        Splenectomy
        Other treatments
        Treatment Complications
        Epidemiology
        Leukemia
        Males > females
        ALL ( 80%) > AML (20%) in children
        CLL affects adults > 65 years
        CML is rare in children
        Coping mechanisms
        Self Compassion
        Achieve Balance
        Managing thoughts
        Financial coping :
        Dh300,000 to Dh400,000
        Local charities
        CML
Impact of the Internet on the Patient’s Understanding
1. survey of 240 family physicians
2. Most have observed patients seeking out “Dr. Google” at increasing rates
3. 97% percent of physicians said their patients are coming into the office with incorrect information.

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"Mohammad’s Spleen is Palpable"

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