Approach to leukemia Quiz: Ace Your Exams
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A 45-year-old man presents to the clinic for evaluation of persistent fatigue, fever, and frequent nosebleeds over the past month. Past medical history is significant for Hodgkin lymphoma 8 years before presentation, which was treated with radiation and a chemotherapy regimen that included doxorubicin, bleomycin, vinblastine, and dacarbazine. Family history is significant for colon cancer in his father. He lives in a residential area that is exposed to radon. Temperature is 37.5°C (99.5°F), heart rate is 102/min, respiratory rate is 18/min, blood pressure is 115/80 mm Hg, and oxygen saturation is 96% on room air. Physical examination reveals mild splenomegaly, pale mucous membranes, and scattered petechiae on the lower extremities. Bloodwork results are shown below. Blood smear shows numerous lymphoblasts. Which of the following factors in this patient’s history likely increased his risk of developing the likely underlying condition?
| Complete Blood Count | Reference Range | ||
| Hemoglobin | 9.2 g/dL | 13.5-17.5 g/dL | |
| White blood cells (WBC) | 60,000/µL | 4,500-11,000/µL | |
| Platelets | 20,000/µL | 150,000-400,000/µL | |
| Neutrophils | 5% | 54-62% | |
| Lymphocytes | 70% | 25-33% | |
| Monocytes | 3% | 3-7% | |
| Eosinophils | 1% | 1-3% | |
| Basophils | 1% | 0-0.75% | |
| Blasts | 20% | 0% |
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