Surgery>>>>>Spleen
Question 9#

Which of the following is an indication for splenectomy in a patient with chronic myelogenous leukemia ( CML)?

A. Failure of chemotherapy to decrease splenomegaly
B. Sequestration requiring transfusion
C. Symptomatic relief of early satiety
D. Presence of bcr gene mutation

Correct Answer is C

Comment:

Chronic myelogenous leukemia (CML) is a disorder of the primitive pluripotent stem cells in the bone marrow, resulting in a significant increase in erythroid, megakaryotic, and pluripotent progenitors in the peripheral blood smear. The genetic hallmark is a transposition between the bcr gene on chromosome 9 and the abl gene on chromosome 22. CML accounts for 7 to 15% of all leukemias, with an incidence of 1.5 in 100,000 in the United States. CML is frequently asymptomatic in the chronic phase, but symptomatic patients often present with the gradual onset of fatigue, anorexia, sweating, and left upper quadrant pain and early satiety secondary to splenomegaly. Enlargement of the spleen is found in roughly one-half of patients with CML. Splenectomy is indicated to ease pain and early satiety.