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A 65-year-old man is admitted to the hospital for a knee replacement. On physical examination, cervical...

A 65-year-old man is admitted to the hospital for a knee replacement. On physical examination, cervical lymphadenopathy was noted. His presurgical CBC values indicated an increased WBC count with relative and absolute lymphocytosis. The technician also made a note of smudge cells present. In your post, consider the following questions:

What is the patient's probable diagnosis based on this information?

What is a smudge cell?

What is the ideal treatment plan?

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Answer #1

(a) based on information probable diagnosis is Chronic lymphocytic leukemia (CLL).

(b) Smudge Cell:-
-Also termed as basket cell.
- these are remnants of cells that lack any identifiable cytoplasmic membrane or nuclear structure.
- mostly associated with abnormally fragile lymphocytes chronic lymphocytic leukemia (CLL).

) Treatment plan for CLL:-

(i) Chemotherapy:-In stronger and healthier patients.
- cyclophosphamide
- High-dose prednisone
- cyclosporine
- cyclophosphamide with rituximab
(ii) Monoclonal antibodies:-
-Obinutuzumab
-Ibrutinib
- Rituximab
(iii) Radiotherapy:- when enlargement of lymph node or spleen is seen-
-low dose radiation
(iv) Leukapharesis
(v) stem cell transplant

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