Muhammed spleen is palpable

Muhammed spleen is palpable

1. Differences between

   • leukocytosis: increase in the number of WBCs .' non neoplastic"
     • Neutrophilic leukocytosis: (count >7000cells/ mm3)
       • Bacterial infections- Corticosteroids (inhinit margination) -Myocardial infarction
     • Lymphocytosis: (Absolute count >4000cells/ mm3
       • Viral infections (infectious mononucleosis) -Drugs (phynetoin)
     • Eosiniophilia
       • Type I hypersensitivity reaction (bronchial asthma- reaction to penicillin)- Helminthic infection
     • Monocytosis
       • Chronic infections : TB
   • leukomoid reaction:This is a reactive and excessive leukocytosis."mimic leukemia"
     • WBC counts up to 15 - 100,000/mm3
     • Shift to the left (immature WBCs)
     • Signs of activation Doehle bodies, toxic granulations (Differs the condition from CML)
       • toxic granulation
       • Doehle bodies
       • NAP scores high (Differs the condition from CML)
       • MPO negative (Myeloperoxidase) to differ from CML

2. Hematological neoplasms

3. Hematological History Taking

4. Hematology Physical Examination

5. Chronic Myeloid Leukemia

   • phases
   • confirming tests
     • FISH
     • PCR
     • Karyotyping
     • Bone Marrow Biopsy in accelerated phase
   • presence of Philadelphia chromosome 22 due to translocation
     • Fusion of 2 genes: BCR (or chromosome 22) and ABL1 (on chromosome 9), resulting in BCR-ABL1 fusion gene
   • Management
     • tyrosine kinase inhibitor
       • imatinib
         • inhibit TK enzyme
     • Hematopoietic stem cell transplantation
   • clinical presentation
     • Asymptomatic
     • abdominal fullness due to splenomegaly
     • weight loss - fatigue

6. Investigations

   • CBC
   • Blood film
     • Blood film at 1000X magnification shows a promyelocyte, an eosinophil, and 3 basophils.
     • Blood film at 400X magnification demonstrates leukocytosis with the presence of precursor cells of the myeloid lineage. In addition, basophilia, eosinophilia, and thrombocytosis can be seen.

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