Chronic Myelomonocytic Leukemia CMML

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Case presentation. A 77 yo previously healthy male, on no meds, hosp in 12/03 for pneumonia, found be anemic (WBC 28.6, Hgb 8.5, Plt 230, 80% N, 5% L, 15% mono, Abs mono 4290)Anemia w/u in 12/03 showed Normal: B12, folate, RBC folate, Fe panel, haptoglobin, LDH, fibrinogen, SPEP, UPEP, TSH, MCV 98

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Chronic Myelomonocytic Leukemia CMML

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1. Chronic Myelomonocytic Leukemia (CMML) Tim Fenske Heme/Onc Grand Rounds June 25, 2004

2. Case presentation A 77 yo previously healthy male, on no meds, hosp in 12/03 for pneumonia, found be anemic (WBC 28.6, Hgb 8.5, Plt 230, 80% N, 5% L, 15% mono, Abs mono 4290) Anemia w/u in 12/03 showed Normal: B12, folate, RBC folate, Fe panel, haptoglobin, LDH, fibrinogen, SPEP, UPEP, TSH, MCV 98 . Abnormal: Urine IFix + for free kappa light chains. Stools guaiac positive. Retic 1.6% Hgb stable in 8.5 – 8.9 range, pt d/c’d with plan for outpt colonoscopy CBC in 2/04 WBC 8.3, Hgb 9.3, Plt 231, MCV 93. 3/04 colonoscopy negative except 1 hyperplastic polyp Routine f/u with primary MD on 5/14/04 WBC 14.4, Hgb 4.9, Plt 54, MCV 100. Diff 58% N, 15% Ly, 28% M. Abs mono 4000 Pt minimally symptomatic except some fatigue with exertion x 2-3 months despite Hgb 4.9

3. Case presentation (2) PE: poor dentition. No gingival hyperplasia. Abdom: mod/massive HSM (spleen 6 cm below CM. Liver 10-12 cm below CM). 5/04 inpatient labs: WBC 14.4, Hgb 4.6, Plt 54, MCV 100 Retic 2.4%, Fe panel, LDH, B12/folate nl PTT 33.6, INR 1.40

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