Topic: oral cancer, cancer cervix, leukemia, glomerulonephritis
Question: Write notes on a)laboratory diagnosis of acute promyelocytic leukemia, b) nephrotic range protienuria and caauses.
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Notes on the laboratory diagnosis of acute promyelocytic leukemia and nephrotic range proteinuria:
a) Laboratory diagnosis of acute promyelocytic leukemia (APL):
– Peripheral blood smear shows abnormal promyelocytes with numerous Auer rods.
– Flow cytometry reveals blast cells expressing CD13, CD33, CD117, and myeloid markers. Negative for HLA-DR.
– Cytogenetics shows t(15;17) translocation leading to PML-RARα fusion gene in >95% cases. Diagnostic hallmark of APL.
– RT-PCR detects PML-RARα fusion transcript. More sensitive than cytogenetics.
– Coagulation tests show increased fibrin degradation products and D-dimers due to disseminated intravascular coagulation.
– Bone marrow aspirate and biopsy shows hypercellular marrow with >20% abnormal promyelocytes.
b) Nephrotic range proteinuria:
– Defined as urinary protein excretion of >3.5 g per 1.73 m2 per day.
– Represents loss of selectivity of glomerular filtration barrier. Allows increased passage of albumin and larger proteins.
– Main causes are primary glomerular diseases like minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis.
– Secondary causes include diabetes mellitus, systemic lupus erythematosus, amyloidosis, multiple myeloma.
– Leads to hypoalbuminemia, edema, hyperlipidemia (nephrotic syndrome).
– Confirmed by 24-hour urine collection for quantitative protein measurement.
– Dipstick urinalysis insensitive for nephrotic range proteinuria.
