Essential Thrombocythemia Followed by Acute Leukemia Does therapy lead to leukemic transition or is it a failure of accurate diagnosis? 63 yo male admitted with Appendicitis Diagnosed with Essential Thrombocythemia 1992. Treated with Chlorambucil to keep platelet count less than 600,000K 1999 diagnosed with AML; cytogenetics normal Offered induction therapy with 7+3. Pt refused. Continued on Chlorambucil. Stable AML x 2 years WS labs. WBC: 14.0, 45% Segs, 7% Bands, 15%Blasts Plts: 693K PCR for BCR/ABL + Objectives Establish the diagnostic criteria for Essential Thrombocythemia (ET) Discuss the natural history of ET Discuss the evidence supporting the treatment of ET Discuss acute Leukemia following ET Diagnostic Criteria for ET Platelet count 600,000 Hematocrit,40 or normal RBC mass Normal serum ferritin and MCV No Philadelphia Chromosome or bcr/abl gene rearrangement Absence of collagen Fibrosis on bone marrow No cytogenetic or morphologic evidence for a myelodysplastic syndrome No cause for reactive thrombocytosis Presenting Features Vasomotor symptoms...

Laboratory Diagnosis of Rhabdomyolysis Definition of Rhabdomyolysis ‘Skeletal muscle injury, reversible or irreversible, that alters the integrity of the cell membrane sufficiently to allow the escape of cell contents into the extracellular fluid, and leakage into the cell of water, Na+, Cl-, and Ca++. Skeletal muscle is the largest organ in the body 40% of body weight Potential for extracellular fluid loss is large Potential for K+, PO4- -, enzymes, proteins, purine release is large ...

Laboratory Evaluation of Renal Disease Blood Tests Blood Urea Nitrogen (BUN) Plasma Creatinine (Cr) Urine Tests Urinalysis ‘Dip Stick’ Sediment Renal Blood Tests (BUN, Cr) The function of the glomerulus is plasma filtration Thus, one measure of renal function is the glomerular filtration rate or GFR Assessment of Glomerular Filtration Creatinine is a product of muscle creatine metabolism Creatinine is released into the blood at a constant rate Assessment of Glomerular Filtration Creatinine is not protein bound and is filtered at the glomerulus Thus it is a useful measure of blood clearance Glomerular Filtration Rate (As measured by Creatinine Clearance) Urine Flow (ml/d) x Ucr (mg/dL) CrCl....

Overview of the Newer Rheumatoid Arthritis Therapies Cyclooxygenase inhibition COX-2–Specific Inhibitor: Celecoxib 12-week, double-blind, randomized trial; 1103 patients with RA in a flare state Celecoxib (100, 200, or 400 mg bid) vs naproxen (500 mg bid) vs placebo Efficacy of celecoxib generally comparable to naproxen Efficacy of all doses of celecoxib similar and superior to placebo on ACR 20, HAQ Disability Index Safety of celecoxib comparable to placebo COX-2–specific at therapeutic doses Incidence of Endoscopic Gastroduodenal Ulcers After Celecoxib Treatment COX-2–Specific Inhibitor: Rofecoxib 52-week double-blind, randomized trial vs diclofenac; 693 patients with osteoarthritis (OA) of knee or hip 6-week double-blind, randomized trial vs ibuprofen; 809 patients with clinical and radiographic knee or hip OA Efficacy of rofecoxib once daily comparable to that of diclofenac or ibuprofen three times daily Safety of rofecoxib comparable to that of placebo COX-2–specific at therapeutic doses Rofecoxib vs Ibuprofen and Placebo:...