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Atypical lymphocytes on manual differential can be:
- Atypical lymphocytes
- lymphoblasts
- myeloblasts
- immature monocytes
Thus, want to keep a broad differential and obtain a smear to evaluate with a hematologist
Posted 10/04/16 10:18:18 AM by Anna Krigel
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Plasma cells in blood -> abnormal and possibly representative of plasma cell leukemia, which is an end-stage of multiple myeloma
Posted 10/04/16 10:19:02 AM by Anna Krigel
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Beta-2 microglobulin
- prognostic marker
- used in CLL and multiple myeloma
- higher level indicative of greater tumor burden
- not as helpful for diagnosis
Posted 10/04/16 10:30:32 AM by Anna Krigel
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Hemophagocytic lymphohistiocytosis (HLH)
- clinical syndrome of excessive immune activation (activation of lymphocytes and macrophages), leads to excessive inflammation and tissue destruction
- most frequently affects infants but occurs in children and adults of all ages
- infection is a common trigger, e.g. EBV viremia can be a driver
- hemophagocytosis occurs normally in the bone marrow; in HLH the immune activation is excessive
Posted 10/04/16 10:55:35 AM by Anna Krigel
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HLH diagnosis - molecular diagnosis of HLH (pathologic gene mutations) or presence of at least 5 of 8 criteria:
- Fever
- Splenomegaly
- Cytopenias
- Hypertriglyceridemia and/or hyperfibrinogenemia
- Documented hemophagocytosis in bone marrow, spleen, or lymph nodes
- Low or absent natural killer cell activity
- Ferritin >500
- CD25 (soluble IL-2 receptor) >2,400
Posted 10/04/16 11:02:28 AM by Anna Krigel
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HLH Management
- High index of suspicion - HLH is a SEPSIS MIMIC and must be on the differential in anyone with rapid onset and progression of sepsis
- Identify and treat potential trigger
- Suppress hypercytokinemia - dexamethasone, Anakinra
- Inhibit T-cell activation - cyclosporine, alemtuzumab
- Block cell division and proliferation - etoposide
Posted 10/04/16 11:10:16 AM by Anna Krigel
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For further reading...
Posted 10/04/16 11:13:03 AM by Anna Krigel