Editing Patient Pathways: Leukemia (section)

== 1. Diagnostics ==

The patient presents with symptoms of frequent infections, chills, fever or chills, fatigue, weakness and malaise, loss of appetite, swollen lymph nodes, bone pain.

Consultation with a general practitioner (GP): The patient visits a general practitioner.

Medical history and physical examination: Detailed medical history of the patient.

Initial tests: gynecological examination, pap test, HPV testing.

'''Referral to a specialist'''

Referral to a radiologist and oncologist.

'''Diagnostic evaluation'''

'''Physical examination:''' Examination to identify signs of anemia (pale skin), bleeding (bruising, petechiae), swollen lymph nodes, spleen, and liver.

'''Laboratory tests'''

'''Complete blood count (CBC):''' Detects abnormal levels of white blood cells, red blood cells, and platelets. It can show an increase or decrease in the number of cells and abnormal cell shapes.

'''Blood smear with differential:''' Detailed analysis of the type of white blood cells and their distribution.

'''Bone marrow aspiration and biopsy:''' Taking a sample of bone marrow for microscopic examination to detect abnormal growth of white blood cells. This procedure helps to diagnose the type of leukemia and its activity.

'''Cytogenetic and Molecular Studies'''

'''Cytogenetic analysis:''' Determines the presence of chromosomal abnormalities, such as the Philadelphia chromosome in CML or specific chromosomal changes in AML and ALL.

'''Molecular tests:''' Identify specific genetic mutations and markers that help in diagnosis and predict response to therapy.

'''Immunophenotyping'''

'''Fluorescent antibodies:''' Used to identify specific surface markers on cells that help classify the type of leukemia (e.g. CD markers in lymphoblastic leukemia).

'''Lumbar puncture'''

'''Lumbar puncture:''' Taking a sample of cerebrospinal fluid to check for the presence of leukemia cells in the central nervous system.

'''Radiological Examinations'''

'''X-ray and CT scan:''' Used to view the size of lymph nodes, spleen, and liver and to assess the spread of the disease in the body.

'''MRI and PET scan:''' Used for a more detailed assessment of the condition and activity of the disease.

'''Cardiac and Hepatic Evaluation'''

'''Echocardiography and liver function tests:''' These tests may be needed before starting treatment to assess general health and organ function due to possible side effects of therapies.

'''Lymphangiography:''' In some cases, it is used to show lymph nodes in the groin and pelvis to determine if they are affected by cancer.

'''Histopathological analysis:''' The biopsy sample is analyzed under a microscope to confirm the presence of cancer and determine the type and stage of the disease.

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