By Drew Provan
Overlaying hematological points of components comparable to pathology, molecular technology, melanoma, and common drugs, this consultant turns out to be useful as a reference for normal perform and medical institution employees, hematologists and trainees in hematology. This moment variation displays advances within the knowing of the molecular biology of illness because the first variation used to be released in 1998.
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Extra resources for ABC of Clinical Haematology
Hughes T, Deininger M, Hochhaus A et al. Monitoring CML patients responding to treatment with tyrosine kinase inhibitors – recommendations for ‘harmonizing’ current methodology for detecting BCR-ABL transcripts and kinase domain mutations and for expressing results. Blood 2006; 108: 28-37. Hughes TP, Kaeda J, Branford S et al. Frequency of major molecular responses to imatinib or interferon alfa plus cytarabine in newly diagnosed chronic myeloid leukemia. New England Journal of Medicine 2003; 349: 1421–30.
3). Marrow examination shows increased cellularity. The distribution of immature leucocytes resembles that seen in the blood film. Red cell production is relatively reduced. g. 4 Peripheral blood film from a patient with chronic myeloid leukaemia showing many mature granulocytes, including two basophils (arrow); a blast cell is prominent (double arrow). 4 Survival from CML • Raised white blood cell count (30–300 × 109/L). 3 Investigations to confirm suspected CML Routine • Full blood count including blood film • Urea, electrolytes, uric acid, lactate dehydrogenase • Reverse transcriptase polymerase chain reaction to detect bcr–abl fusion transcripts • Bone marrow aspirate (degree of cellularity, chromosome analysis) Optional • Bone marrow trephine biopsy (extent of fibrosis) • Fluorescence in situ hybridization for bcr–abl fusion gene in blood cells • Human leucocyte antigen typing for patient and siblings • Vitamin B12 and B12 binding capacity (rarely performed) ing rise to platelets, are plentiful but may be smaller than usual and morphologically atypical.
Dasatinib This second generation tyrosine kinase inhibitor is active against both Abl and Src oncogenes and in vitro studies show it to be about 300 times more active than imatinib. It has demonstrated considera- Chronic Myeloid Leukaemia ble efficacy in patients resistant to imatinib and patients who respond well should probably be continued on the drug indefinitely. The recommended dose is currently 100 mg daily. Nilotinib This agent, also a second generation tyrosine kinase inhibitor, is also active in patients whose leukemia appears resistant to imatinib.