Objectives:

• Recognize the clinical presentation of acute leukemias
• Recognize the clinical presentation of chronic leukemias
• Describe appropriate surveillance for patients with chronic lymphocytic leukemia, and when to initiate treatment
• Identify good and poor prognostic features of leukemias

1		A 46-year-old woman presents to your office for a preoperative evaluation. She is planning an elective hysterectomy for painful, bleeding uterine fibroids. She has no significant past medical history. Her review of systems is positive only for sweats that she suspected were related to the onset of menopause, although her menses are still regular. Her physical examination is unremarkable except for a palpable spleen tip. You obtain a CBC, showing WBC count of 50,000/mm3, hemoglobin 11 g/dl, platelet count 350,000/mm3. On her peripheral blood smear, she has mostly neutrophils and bands, with some metamyelocytes, myelocytes, and basophils as well. All of the following are likely to be true EXCEPT:
			A)	The patient has an underlying infection with leukemoid reaction.
			B)	The patient has a balanced translocation between chromosome 9 and 22.
			C)	The patient produces an abnormal tyrosine kinase protein.
			D)	The patient will likely develop progressive leukocytosis, fevers, anemia, and thrombocytopenia if untreated.