Suspected blasts on peripheral blood smear: Difference between revisions
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m →Suspect or exclude acute promyelocytic leukemia (APL): unprepared |
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If there is even a suspicion of APL, '''consult''' commensurately with any readily available colleague(s), and ensure that the following will be done, '''without waiting''' for any additional workup, and without waiting for the regular work hours of any people with more expertise: | If there is even a suspicion of APL, '''consult''' commensurately with any readily available colleague(s), and ensure that the following will be done, '''without waiting''' for any additional workup, and without waiting for the regular work hours of any people with more expertise: | ||
*That any outpatient '''seeks the emergency department''' to be admitted (such as by having the ordering physician or another clinician call the patient, or call yourself). | *That any outpatient '''seeks the emergency department''' to be admitted (such as by having the ordering physician or another clinician call the patient, or call yourself). | ||
*That the patient will be '''treated''' by a clinician who knows your suspicion of APL, as well as the urgency and drug of choice for initial treatment (such as an oncologist or hematologist on call, but it may not be emergency room | *That the patient will be '''treated''' by a clinician who knows your suspicion of APL, as well as the urgency and drug of choice for initial treatment (such as an oncologist or hematologist on call, but it may not be an unprepared emergency room team).<ref group=note>The reason for the urgent reporting and treatment of suspected APL is that even a suspected APL mandates immediate initiation of ATRA treatment before confirming or disproving the diagnosis by further workup. It is much better to make a false positive call and have a patient treated with a vitamin A-like drug, rather than delaying or missing a report of APL, and thereby delay the initiation of treatment which can quickly be fatal. After all, the initial treatment only costs about $40 as a first dose.<br>- '''Indication for treatment''': {{cite journal| author=Sanz MA, Fenaux P, Tallman MS, Estey EH, Löwenberg B, Naoe T | display-authors=etal| title=Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet. | journal=Blood | year= 2019 | volume= 133 | issue= 15 | pages= 1630-1643 | pmid=30803991 | doi=10.1182/blood-2019-01-894980 | pmc=6509567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30803991 }}<br>- '''Cost of treatment''': Dosage of ATRA in APL is 45 mg/m<sup>2</sup>/day administered as two evenly divided doses, which for a typical adult is about 40 mg as a first dose. The cost per 10mg capsule is about $10.<br>- '''Dosage reference''': {{cite journal| author=Osman AEG, Anderson J, Churpek JE, Christ TN, Curran E, Godley LA | display-authors=etal| title=Treatment of Acute Promyelocytic Leukemia in Adults. | journal=J Oncol Pract | year= 2018 | volume= 14 | issue= 11 | pages= 649-657 | pmid=30423270 | doi=10.1200/JOP.18.00328 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423270 }} | ||
<br>- '''Cost''' per 10mg capsule: {{cite web|url=https://www.pharmacychecker.com/vesanoid/#!|title=Vesanoid Prices|website=pharmacychecker.com|accessdate=2022-11-09}}<br>The treatment must be started immediately to counteract severe coagulopathy of untreated APL.</ref> | <br>- '''Cost''' per 10mg capsule: {{cite web|url=https://www.pharmacychecker.com/vesanoid/#!|title=Vesanoid Prices|website=pharmacychecker.com|accessdate=2022-11-09}}<br>The treatment must be started immediately to counteract severe coagulopathy of untreated APL.</ref> | ||