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Cancer
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Elyce Cardonick, Charlotte Maggen, Puja Patel
The clinical behavior of HD during pregnancy does not appear to differ from non-pregnant women. Pregnant women can present with a cough, night sweats, and weight loss. A patient with such complaints should have a complete physical exam and clavicular adenopathy can be safely biopsied during pregnancy. Pruritis unrelated to cholestasis of pregnancy, nor relieved with delivery should raise suspicion. A chest x-ray can be performed safely with minimal fetal exposure. A bone marrow biopsy can also be safely performed with appropriate analgesia.
Clinical haematology (and immunology and oncology)
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
A sign shared by all myeloproliferative disorders (with the exception of essential thrombocytosis) is an enlarged spleen, which can be detected during a routine physical examination. In addition to performing a physical exam, the doctor may also conduct the following tests: Blood tests – detect abnormal types or numbers of red or white blood cells. They can also detect anaemia and leukaemia.Bone marrow biopsy – sample of bone marrow may be taken after blood tests. It can show the presence of abnormal types or numbers of red or white blood cells and may detect certain types of anaemia and cancer in the marrow.Cytogenetic analysis – blood or bone marrow are viewed under a microscope to look for changes in the chromosomes.
The blood
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Alastair Duncan, Santosh Patel
A detailed history may suggest organ involvement and may highlight any known trigger agents. All patients with suspected systemic involvement should have a full blood count and a peripheral smear to exclude an associated haematological disorder. Abnormal findings should prompt a bone marrow biopsy. Although liver function tests are usually normal, an abdominal ultrasound scan should be performed to rule out hepatic or splenic involvement.
Secondary erythrocytosis
Published in Expert Review of Hematology, 2023
Rodrick Babakhanlou, Srdan Verstovsek, Naveen Pemmaraju, Cristhiam M. Rojas-Hernandez
Although secondary erythrocytosis is more common than PV, there are still challenges and difficulties associated with the distinction between those two conditions. Despite the WHO statement that JAK-2 gene mutations together with a serum EPO assay and bone marrow histology would suffice to distinguish between polycythemia vera from secondary erythrocytosis [22], it is important to keep in mind that it is a misconception that JAK2 V617F expression is always associated with abnormal marrow morphology, as some polycythemia vera patients do not express a JAK2 mutation. Even a bone marrow biopsy can be normal. The measurement of EPO levels is not helpful, as in one third of patients, they can be normal [13]. If PV is clinically suspected and the EPO levels are subnormal with the absence of JAK2 V617F or exon 12 mutations, further testing for other myeloproliferative neoplasm-associated mutations, such as CALR and SH2B3/LNK, may be pursued.
Autoimmune disorders associated with common variable immunodeficiency: prediction, diagnosis, and treatment
Published in Expert Review of Clinical Immunology, 2022
Niloufar Yazdanpanah, Nima Rezaei
The main factor in the diagnosis of autoimmune cytopenia is persistent abnormal complete blood count (CBC) results in laboratory testing. Furthermore, evaluation of peripheral blood smear (PBS) is helpful. In cases of evident abnormality in more than one lineage, bone marrow biopsy is recommended to exclude malignancy and bone marrow failure. Laboratory markers of hemolysis and Coombs test are useful for diagnosis. Detection of antibodies against the blood components such as anti-platelet and anti-neutrophil antibodies are not acceptable by most of the clinicians to make the diagnosis upon; a negative test for these antibodies does not exclude the diagnosis. As the underlying mechanism in most cases with autoimmune cytopenia is based on immune-mediated destruction and/or sequestration, the patient’s bone marrow reserves would be normal and it would be probable to observe an arrest in late stages of maturation process.
An unusual presentation of an uncommon lymphoma, hepatosplenic T-cell lymphoma
Published in Baylor University Medical Center Proceedings, 2019
Sima Amin, Sarah K. Findeis, Andrew Whiteley, John R. Krause
Needle core biopsy of the liver showed portal tracts and sinusoids infiltrated by atypical lymphocytes, including small, round lymphocytes associated with spotty hepatocellular apoptosis and rare foci of confluent multicellular necrosis (Figure 1b). Immunohistochemistry confirmed that the cells were of a T-cell lineage, with positive staining for CD8 (Figure 1c) and CD3 and negative staining for CD4 and CD20. TIA-1 was positive and Ki-67 showed positive staining within 90% of the cells. Staining for αβ TCR and γδ TCR were negative, but a γδ TCR rearrangement was identified on polymerase chain reaction (PCR). A bone marrow biopsy was done. Although an infiltrate was not appreciated by morphology or by stains and flow cytometry on the bone marrow biopsy, a γδ TCR rearrangement was detected by PCR. A mesenteric biopsy showed no evidence of a lymphoproliferative disease.