Week 1 -Summer immersion

The first day I came, I was introduced to the team and joined them for a bone marrow biopsy. The patient was an older male with high blood counts and kidney failure. A bone marrow biopsy was needed to determine what type of malignancy he has. Another case I saw on my first day was 40 years old male with high cytokine levels and a beginning stage of liver failure in ICU. He did not have any malignancies but doctors suspected secondary hemophagocytic lymphohistiocytosis (HLH) which is extremely rare condition. Both cases were complex and required multiple consults between physicians. During the week I was able to see how to process of diagnosing a patient works and how depending on the results treatment changes. I saw how doctors mainly can not come up with a treatment plan if the technician, pathologist, and other specialized lab personnel are not providing them with the results of the biopsy. In order to diagnose any type of leukemia, they order multiple tests like immunostaining, flow cytometry, and PCR for leukemia-specific sequencing, along with genetic testing (FISH). 

 In the case of the liver failing patient, they were considering a liver transplant since the patient was relatively young but due to a potential HLH diagnosis, his eligibility for a liver transplant was questionable. I listened to discussions between doctors regarding organ transplant requirements and all concerns they had in this particular case. It was interesting to see how there are strict rules and guidelines that needed to be followed, but they were not able to diagnose the patient with HLH since the symptoms he had were common in both HLH and liver failure cases. This was an extremely difficult case in which a bad patient prognosis and doctors were preparing the patient family for the worst-case scenario. Over the week patient's condition deteriorated more and he had brain bleeding resulting in the patient passing away. Interestingly, the patient had no disease history and was relatively healthy until 2 weeks ago when his symptoms started with hypoxia and fever. His blood work showed an extremely high number of HSV replicates and HLH seemed to be secondary to that virus infection.  

The second patient was suspected to have monocytic leukemia based on the immunostaining and flow cytometry results, but his biopsy sample was not able to provide a lot of information. He started with steroid treatment which helped to improve the patient's condition. Another biopsy was needed to confirm his diagnosis of monocytic  AML but when the results came back the number of monocytes present in peripheral blood and bone marrow was not meeting the diagnosis as there were no blasts present which was confusing. Dr. Kaner suspected intravascular lymphoma as it shows out as leukemia but it is extremely rare and hard to diagnose. 

The two cases described above showed me how complicated diagnosing a patient can be. I also joined Dr. Kaner's team for rounds this week and discussed my research project. In the lab, I started getting the required training and showed some of the chips I fabricated in Ithaca.