Failure to Diagnose & Delay in Treatment of Leukemia (Blood Cancer)

Evaluate breaches in the standard of care when determining Failure to Diagnose & Delay in Treatment of Leukemia (Blood Cancer)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Frequent infection
    Symptoms not elicited
    Answer unknown
    Swelling of lymph nodes
    Weight loss
    Bleeding tendency
    Weakness
    Why is this important?
    The symptoms of leukemia vary depending upon the type of leukemia. Often leukemia presents with frequent infections, swelling of the lymph nodes, weight loss, bleeding tendency and weakness.
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  • Was a detailed medical history obtained and documented? Why is this important?
    Answer this question
    A repeated history of infection is suggestive of poor immunity that could be due to leukemia. Therefore, a detailed medical history of the patient is insightful and necessary.
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  • Was physical examination performed? Why is this important?
    Answer this question
    A physical examination needs to be performed to assess for swollen lymph nodes, an enlarged spleen and an enlarged liver. Physical signs may also include; pallor, bruising, fever, ecchymosis/petechiae, purpuric rash, lymphadenopathy, gingival enlargement, gingival bleeding and sternal tenderness.
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  • Was the patient discharged with a diagnosis other than leukemia? Why is this important?
    Answer this question
    Patients presenting to the clinician with signs of infection may be discharged home with a differential diagnosis of infection.
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  • Which of the following laboratory studies were recommended? (Choose all that apply) Why is this important?
    Answer this question
    Blood tests are an invaluable diagnostic tool for the evaluation of leukemia.Complete blood count (CBC) with differential should be performed in all patients. An elevated leukocyte count (>10 × 109/L) is found in 50% of patients. Leukocyte count is an important aspect of risk stratification for therapy and prognosis. Other features observed may include anemia, thrombocytopenia, and neutropenia to varying degrees.
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  • What was the result of the blood investigations? Why is this important?
    Answer this question
    When an abnormality is detected in the blood work, it is necessary for the patient to be referred to a hematologist/oncologist for further evaluation and management.
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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Regular follow-up physical examinations, laboratory studies and diagnostic imaging evaluations are needed for effective follow-up care.
    (2002) 16 EHOCNA 4 907-926

  • Did the clinician refer the patient to a specialist? Why is this important?
    Answer this question
    Referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.
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  • What was the result of the bone marrow biopsy? Why is this important?
    Answer this question
    When the results of an analysis of peripheral blood suggest the possibility of leukemia, the bone marrow should be examined promptly to confirm or discount the diagnosis. It is important that all studies necessary to confirm a diagnosis and adequately classify the type of leukemia be performed, including bone marrow aspiration and biopsy, flow cytometry, cytogenetics, and molecular studies.
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  • With which type of leukemia was the patient diagnosed? Why is this important?
    Answer this question
    Acute lymphoblastic leukemia (ALL) is a heterogeneous group of malignancies with a number of distinctive genetic abnormalities that result in varying clinical behaviors and responses to therapy. The production of symptoms and signs of AML is due to replacement of bone marrow by malignant cells and due to secondary bone marrow failure. CML is a clonal disorder of the hematopoietic tissue that accounts for 2-3% of all cases of childhood leukemia.
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  • Was staging of the leukemia performed? Why is this important?
    Answer this question
    Leukemia is conceptualized as a disseminated malignancy of the hematopoietic system and therefore traditional staging is not used as for lymphoma and solid tumors.
    (2011) 49 ERDCNA 4 767-797

  • Which of the following additional tests were performed? (Choose all that apply) Why is this important?
    Answer this question
    The diagnosis of acute leukemias emerged from cytomorphology alone, advancing to a comprehensive bundle of different methods that are necessary for the diagnosis, classification, and for individual treatment decisions.
    (2005) 56 ECRONH 2 223-234

  • Which of the following diagnostic studies were performed to assess metastases?(Choose all that apply) Why is this important?
    Answer this question
    Leukemic involvement of the solid viscera, especially the spleen and thymus, is common, and manifests as organomegaly.
    (2011) 49 ERDCNA 4 767-797

  • Which of the following tests were performed before initiating chemotherapy? (Choose all that apply) Why is this important?
    Answer this question
    Tumor Lysis Syndrome (TLS)is the constellation of metabolic abnormalities that can result from abrupt destruction of tumor cell with subsequent release of intracellular contents into the circulation resulting in a disruption of homeostasis.

  • Which of the following interventions were performed to avoidi Tumor Lysis Syndrome (TLS)? (Choose all that apply) Why is this important?
    Answer this question
    Delayed recognition of the metabolic imbalances caused by the massive release of tumor cell contents may result in clinical complications. The mainstays of TLS management include the monitoring of electrolytes, intravenous hydration, prophylacticanti-hyperuricemic therapy with allopurinol, and rasburicase treatment.
    (2010) 36 ECANTR 2 164-176

  • Was treatment initiated for leukemia? Why is this important?
    Answer this question
    It is required that leukemia, once diagnosed, be treated immediately. Treatment will vary with cell differentiation.
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  • Which of the following prophylactic therapies were initiated? Why is this important?
    Answer this question
    The routine use of Central Nervous System (CNS) prophylaxis has improved the long-term prognosis of patients.
    (2001) 15 EHOCNA 1 145-162

  • Was a bone marrow biopsy recommended? Why is this important?
    Answer this question
    When the results of an analysis of peripheral blood suggest the possibility of leukemia, the bone marrow biopsy should be done promptly to confirm or discount the diagnosis.
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