The evaluation in a newly diagnosed case of acute lymphoid leukemia (ALL) should routinely include?
A. bone marrow biopsyB. cell-surface phenotyping
C. complete metabolic panel
D. Plasma viscosity
E. Immunologic cell-surface marker testing
Answer. A. bone marrow biopsy; (B) cell-surface
phenotyping; (C) complete metabolic panel; (E)Immunologic cell-surface marker testing
Viscosity testing is typically reserved
for cases of multiple myeloma where paraproteins (particularly IgM) can lead to
vascular sludging and subsequent tissue ischemia. ALL can lead to end-organ
abnormalities in kidney and liver therefore routine chemistry tests are
indicated. A lumbar puncture must be performed in cases of newly diagnosed ALL
to rule out spread of disease to the central nervous system. Bone marrow biopsy
reveals the degree of marrow infiltration and is often necessary for
classification of the tumor. Immunologic cell-surface marker testing often
identifies the cell lineage involved and the type of tumor, information that is
often impossible to discern from morphologic interpretation alone. Cytogenetic
testing provides key prognostic information on the disease natural history.
