MEDizzy - A 55-year-old man has had fatigue, fever, and episodes of

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Combined Hematology II

A 55-year-old man has had fatigue, fever, and episodes of epistaxis for the past 3 months. On physical examination his temperature is 37.4 °C. Laboratory studies show Hgb 12.5 g/dL, Hct 37.6%, MCV 89 fL, platelet count 170,000/microliter, and WBC count 52,000/microliter. Examination of his peripheral blood smear shows large blasts with Auer rods. Which of the following risk factors most likely preceded development of his current illness?

ExplanationD. Out of all the options only myelodysplasia can lead to secondary AML. Secondary acute myeloid leukemia may arise from the previous clonal disorder of hematopoiesis, usually from myelodysplastic syndrome (MDS) or from chronic myeloproliferative neoplasia (cMPN) or after exposure to a leukemogenic agent (previous chemotherapy or radiotherapy, some immunosuppressive drugs or environmental leukemogenic agents). Secondary origin of AML is associated with unfavorable prognosis and it is not considered to be conventionally curable (with the exception of secondary acute promyelocytic leukemia). Patients with secondary AML are older and less commonly treated with curative intention than those with primary AML. According to cytogenetic findings, their prognosis is often worse. Complete hematologic remission is achieved with a low probability, relapse of the disease occurs frequently and overall survival is worse in almost all prognostic subgroup.