Ann spoke at the acs dedication today through skype…her father was a past director. If you didn’t hear it it was really moving and a great tribute. The whole service was moving.

Ann’s father passed around 8:40 PM EST tonight, 19 September, 2007. Please remember her in your thoughts and prayers. Bob

Davis is creating a new AMMC building….this will take time. Dont be distressed if you come to us and find a building in pieces. It should be great when we’re finished.

It’s 1:24 PM PDT and CC Carnell and four students have arrived.

I’m trying to get a picture, so CC hid behind me…little did she know I’m evil. 

It’s 1:44 pm PDT and we’re starting with a few basics about HCL

 1:56 PM PDT, we’re discussing factors. Interesting things the students are finding from their searches. Vera mentioned the suicide gene RB 1.P53.

2:00 PM PDT: How can you differentiate HCL from CLL 

Berci says: “TRAP” Good Berci. Also, PE, CBC, Periphereal blood smear, bone marrow, immunophenotyping, CT scan (if it’s lymphadenopathy, it usually means CLL).

We’ll all be glad when Berci is back to blogging!

I’m going to try Berci’s trick and live blog an early discussion with Nat and Kenna. 

[10:19]  You: So what is hcl?
[10:19]  Natalie Balogh: Hairy cell leukemia
[10:20]  You: Ya, but what is it?
[10:20]  Kenna McMillan: A chronic leukemia of b cells?
[10:20]  You: differentiated or undifferentiated?
[10:21]  Natalie Balogh: I remember you said last week that it was well differentiated B lymphocytes

[10:23]  Kenna McMillan: Wan’t there something about radiation exposure…like benzene?
[10:23]  You: Yah, good!
[10:23]  Natalie Balogh: It effects mostly men over 50
[10:24]  You: Well…the median age range is 50, yah 

10:29]  You: do you know the clinical features?
[10:29]  Natalie Balogh: Like weakness, splenomegaly?
[10:29]  You: Yah
[10:29]  You: Clinical features and incidences?
[10:30]  Natalie Balogh: I think you mentioned that splenomegaly was like 90% incidence in HCL
[10:30]  You: Good, yah
[10:31]  Kenna McMillan: We know marrow fibrosis is a feature
[10:31]  You: Clinical features, though…like weakness
[10:32]  Natalie Balogh: You said that due to the spleen a lot of pts feel full, bloated?
[10:32]  You: Yes
[10:32]  You: the incidence is about 25% with accompanying weight loss

[11:08]  Natalie Balogh: do patients still have splenectomies performed?
[11:08]  You: Sometimes, but usually it’s avoided if possible
[11:08]  You: we also use interferon alpha MAB
[11:08]  You: it’s known as rituximab
[11:09]  You: It’s successful in 70% of the cases
[11:09]  Natalie Balogh: wow..so it’s highy curable
[11:09]  You: Very much so
[11:09]  You: we use 2 CdA or DCF if treatment is needed most often
[11:10]  You: But like I said, these are highly immunosuppressive
[11:10]  Natalie Balogh: What are the cure rates with those drugs
[11:10]  You: Mmm, about 10% of pt are resistant to both drugs, so have to take a different route
[11:11]  You: usually with interferon alpha
[11:11]  You: with pentostatin 60% achieve full remission
[11:12]  You: 25 % achieve partial remission with DCF (pentostatin)
[11:13]  You: with 2 CdA 90% achieve total remission
[11:13]  Natalie Balogh: omg 90%?!?!?!
[11:13]  You: Yah..so it is hightly curable
[11:13]  You: Usually the remainder receive some long-term responsivness
[11:14]  You: it’s rare that a person relapses or has resistance to 2 CdA

 Come join us for the fun

Good job to the students for figuring out that the pt has hcl…hairy cell leukemia. We’ll be having a q&a session next week.

The exercise on Aug 9, 2007 has been moved to 11 am PDT instead of 9 am. Please make a note.

I’m holding a training exercise on the 9th of August around 9 or 10 am SLT (PDT). I’ll present as a heme pt and give you students some clues, including labs…i might even give you an microscopic image, altho this will be a huge clue. You’ll take time to talk as a group and make some decisions as what test to run and about the diagnosis. Last we’ll have a round table type discussion, where I’ll ask you some questions and provide you some answers. Mainly, I want you to interact as colleagues and have some fun…and hopefully learn a few things.

Bob