Clinical Workup

A full history and physical examination should be performed with special attention to any preceding history of blood disorder or malignancy, past chemotherapy or radiation treatments, occupational exposure, family history, general performance status, age of the patient, signs/symptoms of infection, and extramedullary signs of leukemia involvement. Risk factors associated with adverse outcome in AML include age greater than 60 years, poor performance status, secondary AML, white blood count greater than 30,000/mm3 and an elevated LDH.13101 Tests performed at diagnosis should include a CBC with differential, comprehensive metabolic panel, uric acid, LDH, prothrombin time, partial thromboplastin time, fibrinogen, and chest X-ray (with posterior anterior and lateral views). HLA typing (serology) should also be performed in case a patient becomes alloimmunized to random donor platelet transfusions and requires HLA-matched platelets during his or her treatment course. HLA typing at the DNA level should be performed on any patient who may be a stem cell transplant candidate in the future. It is best for HLA typing to be done prior to the initiation of chemotherapy, when more cells are present. A multiple gated acquisition scan should be done to assess cardiac function, as induction chemotherapy regimens for AML include an anthracycline. In addition, an indwelling venous catheter (i.e., Hickman catheter) should be placed for blood draws, blood product transfusions, fluid management, and antibiotic administration.2 A lumbar puncture is not a routine part of the work-up unless there is clinical suspicion for CNS leukemia.

Patients who are neutropenic and febrile should have blood cultures drawn and should be started on appropriate broad-spectrum antibiotics. Most patients will also require transfusions of packed red cells and

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