Acute Leukemia - General Diagnostic Approach on Admission ...

Acute Leukemia - General Diagnostic Approach on Admission - Checklist

 • History: Note sibling status (for donor search), and if pre/peri menopausal, obtain date of last LMP, full ROS

 • Laboratory workup:

    - Peripheral smear: Anemia, thrombocytopenia, variable WBC, circulating blasts, Auer rods (indicates myeloid origin)

    - Peripheral flow cytometry: Collect in yellow top tube, label “new leukemia rush,” bring to Warren 506

    - Screening labs: CBC w/ diff, BMP, LFTs, coags, UA, bHCG, HBV/HCV, CMV IgG, T&S

    - DIC labs: CBC, PT/PTT/INR, fibrinogen, D-dimer (esp if concern for APL)

    - TLS labs: BMP, LDH, Uric acid, Ca, Mg, Phos; diagnosis requires 2 lab (↑Uric acid, ↑K, ↑PO4, ↓Ca) + 1 clinical (AKI,

arrhythmia, sz) criteria

 • BM Bx: >20% blasts, flow cytometry, cytogenetics (karyotype, FISH), molecular testing (FLT3 ITD/TKD, NPM1, IDH1/2)

 • Studies: EKG, CXR, TTE (needed prior to induction due to cardiotoxic chemotherapies), +/-CT head (if CNS sx)

 • Access: double-lumen Hickman vs. triple-lumen PICC in anticipation of chemotherapy. Coordinate central access with attending.

 • LP +/- intrathecal chemo: Indications for LP include all ALL; AML w/ CNS or ocular symptoms; APL with systemic relapse

    - CT or MRI before LP: AMS, focal neurologic signs, papilledema, seizure within the last week

 • HLA-typing, HSCT work-up (if ≤ 80 yo): Collect in 2 yellow top tubes, send to American Red Cross; siblings>parent/children as donor

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