Goljan clairification

[TrapperJohnMD]

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Couple points:

In the RR book, in the hematology section under anemias, Goljan talks about the corrected reticulocyte count and the cut off point for an appropriate response being 3%. I think in his lecture he says 3% sometimes and 2% at other times. Any idea which is correct?

For chronic vs acute leukemias in general: The book says acute will have 20% blasts or higher, while chronic has 10% or lower. In the lecture he says <30%= Chronic and >30%= Acute. hmmmmmm???

Am I missing something, is he inconsistent, or am I getting caught up in the details? Thanks!

 

[lunartune]

Hi,

I just happened to solve a question about that (Board Simulator). The explanation says that a reticulocyte count < 2% is considered as an inappropiate answer of the bone marrow. Values > 3% are considered as a good bone marrow response.

About the leukemias: No idea about the percentage but what I understood from his lectures, it's more important to have a look at the age bracket. In acute leukemias, leukos will be high (>60000), in chronic lower (~30000).

I think the big picture should be clear. If 20 or 30% - who cares, in 5 days you will have forgotten that detail anyway 😉

Happy studying! lt

 

[Sage880]

Well, you're never going to confuse ALL and CLL so it's not as important for that.

For AML and CML it's not as obvious. With a semi high blast count is it AML or CML with a blast crisis? You need histological analysis.

That's real life. On step 1 it couldn't be more clearer. They will make it so obvious which one it is you will never even really have to think about the blast count - in fact I don't think I've ever even seen it given in a question.

 

[TrapperJohnMD]

Good enough for me.

Thanks guys!

 

[TrapperJohnMD]

I guess this is more of a FA07 clairification than a Goljan one but here goes:

Why does it say on page 308 in Hem/onc section, in the graph that TIBC is normal, or even increased in iron overload disease. it seems like this should be decreased because -as per goljan: increased iron, increased iron stores, increased ferritin, siginal to liver to decrease transferrin, decreased TIBC.

 

[Sage880]

Yeah, I've actually heard that argued both ways but I like the way goljan explains it. Again, it sounds like you understand the concept, which is what you need for the exam.

If you were actually forced to pick a range on a graph (like iron vs TIBC) for iron overload disease, pick high Iron and high TIBC. Doesn't make sense the way goljan explains it but that's the right answer. Trust me, I go to school in Ireland and that's what they look for here when working up Hemochromatosis.