What if an aspirate cannot be obtained on my patient?

Published on May 31, 2017 in Diagnosis

Keith W. Pratz, MD
Assistant Professor of Oncology
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins University
Baltimore, Maryland

Welcome to Managing AML. I am Dr. Keith Pratz. I am frequently asked, “What if an aspirate cannot be obtained on my patient?” Aspirates for the diagnosis of acute myeloid leukemia are critically important. They provide several important pieces of information including the differential and the number of blasts assessed via immunohistochemistry or flow cytometry. The most important feature obtained from the aspirate are the genetics for risk stratification and/or therapeutic treatments. In patients who cannot have an aspirate obtained, a certain number of those patients can have a genetic analysis done on peripheral blood. It is generally only valid in patients who have a significant amount of circulating leukemia. Greater than 20% blasts can allow for appropriate genetic testing of the leukemia from the peripheral blood. Alternatives include taking a second core biopsy and asking your pathologist to process the second core specifically for cytogenetics, FISH (fluorescence in situ hybridization), and molecular studies. In those circumstances, it does allow for not only the core testing to be done, but the genetics which are very important in 2017. Thank you for reviewing this activity.

Last modified: May 26, 2017

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