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Pulmonology Quiz


Question Information

 
Question Date:
  06/29/2010
Submitted by:
  Administrator
Affiliation:
  QuestionPursuit

Question

 

32 yr old presents with a 2 month history of fatigue, weakness and night sweats and unintentional 5 pound weight loss.  Physical exam is remarkable only for a few petechiae on the lower extremities.

Laboratory testing reveals:

WBC 241.2 (2% lymphocytes, 4% neutrophils, 1% monocytes, 2% myelocytes, 90% myeloblasts, 1% basophils).

Hb 7.2 gm/dl

Platelets 24,000

Na 138, K 3.9, Chloride 112, HCO3 18, BUN 12, Cr 0.9, Glucose 102

TB 0.9, AST 53, ALT 33, Alk Phos 102

LDH 479

Bone marrow biopsy/asp:  Hypercellular marrow, 95% CD 33 (+) myeloblasts.

The patient complains of dyspnea and diffuse pleuritic chest pain.  O2 sat is 89% on room air.  He complains of mild headache and dizziness.

Chest x-ray is without abnormality.

Of the following options, the next best step in the management of this patient is:

  1.  Type and cross and transfuse 2 units of irradiated, leukoreduced pRBCs
  2.  Leukapheresis
  3.  Low molecular weight heparin
  4.  Platelet transfusion, irradiated