Advanced Pathophysiology Case Study Question Set Adapted

Advanced Pathophysiology Case Study Question Set Adapted from https://www.hematology.org/education/trainees/fellows/case-studies/new-therapies-for-acute-myeloid-leukemia A 76-year-old woman presents to the emergency department following two weeks of progressive dyspnea and fatigue, and a new rash. Her medical history is significant for coronary artery disease and diabetes. Physical examination results are within normal limits, except for BP 160/90, skin pallor, and a petechial rash on the lower extremities bilaterally. Complete blood count with differential is significant for a white blood cell count of 18 × 109/L with 40 percent circulating blasts, hemoglobin 6.7 g/dL, and platelet count of 20 × 109/L. A bone marrow biopsy reveals a hypercellular marrow with 22 percent blasts, consistent with a diagnosis of acute myeloid leukemia (AML). What impact does the patient’s acute myeloid leukemia (AML) have that would be responsible for her pallor? (Hint for this and several other questions: think about what cells give rise to the different formed elements found in blood.) 2. What impact does the patient’s AML have that would be directly responsible for her petechial rash? 3. What aspect of blood clotting would be less affected (or more indirectly affected) than your answer to #2? 4. What impact does the patient’s AML have that would put this patient at higher risk of developing an infection? 5. Which part of the patient’s immune system is directly affected by the AML? 6. Which part of the patient’s immune system is more indirectly affected by the AML? Describe in what way it is affected. 7. AML is a cancer of blood stem cells. As with any cancer (out-of-control cell proliferation), mutations must have occurred in various genes that led to the dysregulated growth. In general terms, what kinds of mutations (gain of function/loss of function) in what kinds of genes are responsible for the overgrowth of cells that we call cancer? 8. The patient’s age (>75) makes her a better candidate for a targeted treatment regimen that combines drugs like azacitidine and venetoclax rather than more traditional chemotherapy. What is it about traditional chemotherapy that makes it necessary to consider the patient’s age when deciding on a treatment regimen? 9. Unrelated to the patient’s leukemia diagnosis, in what way does a patient’s diabetes impact the development of coronary artery disease? In other words, what is the effect of hyperglycemia on the blood vessels and what consequences does that effect have? 10. The patient’s pulse pressure is > 60. This large a difference between systolic and diastolic pressures is indicative of what problem commonly seen in older patients?

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