Check out today’s Step 2 CK Qmax Question Challenge.
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A 32-year-old man with trisomy 21 presents with fatigue and swollen, bleeding gums for the past 5 days. He lives in a group home, and was formerly employed in a factory manufacturing hair products. He has smoked 1 pack of cigarettes per day for the past 15 years. He denies use of alcohol or illicit drugs. Physical examination reveals pallor, diffuse petechiae, oozing oral mucosa, and splenomegaly. Bone marrow aspirate reveals the type of cell shown in the image.
Which of the following risk factors contributed most to the development of the patient’s condition?
A. Age <40 years
B. Down’s syndrome (trisomy 21)
C. Exposure to Epstein-Barr virus in his home
D. History of smoking
E. Prior lead exposure
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B
B
b
B
we all fall down
B
The photo depicts Auer rods. Auer rods are commonly seen in patients with AML-M3.
The correct answer is B. The bone marrow aspirate reveals the presence of Auer rods. These red-staining structures are abnormal azurophilic granules that are very numerous in acute myelogenous leukemia (AML). The patient’s presentation is consistent with the manifestations of a leukocytosis (as is found in AML), leading to anemia and thrombocytopenia, as well as splenomegaly. Compared to the general population, patients with Down’s syndrome are 20 times more likely to develop acute leukemias.
A is not correct. AML is a disease of advancing age, and >50% of cases occur in persons >60 years of age.
C is not correct. Although exposure to Epstein-Barr virus has been implicated in the development of some types of lymphoma and carcinoma, there is no known association with AML.
D is not correct. Smoking contributes to an individual’s risk of developing lung carcinoma and several other tumors, but is not known to specifically increase the risk of leukemia.
E is not correct. Exposure to alkylating agents, such as chemotherapeutics, increases the risk of development of AML, as does exposure to benzene. There is no known association with lead exposure.