Canterbury DHB

Context

Pre-Treatment Investigations for New AML Patients

The investigations listed here are appropriate for any new patient with AML, ALL, and Burkitt-like Leukaemia/ Lymphoma who is scheduled to receive intensive treatment. The extent of any investigations to be carried out on other patients with these conditions will be decided by the Consultant.

For anyone that might be entered into any trial, also phone Trial Coordinators (Helen McDermott, Carolyn Lauren, Jemma Hurcomb, or Natalie Meijer) on 80377 or 80386.

It is very important that the Laboratory Registrar also directly contacts Molecular Oncology (Geraldine Duncan or Kym Drake) on 86008 and cytogenetics (Jill Cochrane-Williams, Rebecca Day, or Elsa Parker) on 80881 or 86007.

In all patients, irrespective of whether they enter a trial, 2–3 mL bone marrow or 10 mL peripheral blood should be sent to molecular haematology.

 

Test Required

Volume of Blood/Container

Blood Tests

CBCD + F, retics, DIC profile, Serum B12, serum and red cell folate

3 x 5 mL EDTA (mauve top), 1 x 5 mL citrate, 1 x 5 mL plain

 

For all patients being potentially considered for AML19, send peripheral blood for molecular biology clearly labelled as "possible AML19 patient".

4 x EDTA tubes.

 

HEMO profile, urate, Ferritin, iron studies, SPE, Ig levels, thyroid function

1 x 5 mL heparin, 1 x 5 mL plain

 

Blood group & red cell antibodies

1 x 7.5 mL EDTA (pink top)

 

Viral serology-HbsAg, HCV, Herpes simplex/zoster, CMV. HIV test

Please make it clear that it is CMV serology (not viral load) that is needed.

1 x 5 mL plain (request long term storage)

 

*HLA Typing

2 x 10 mL CPDA (yellow top), 1 x 10 mL plain, 1 x 6 mL EDTA (pink top).

This sometimes gets missed so please follow up and check it has been done, ideally before treatment begins. Contact SCT Coordinator so they know who the patient is.

Bone Marrow

Bone marrow aspirate and trephine (if the blast count is very high, very occasionally this may not be necessary, discuss with consultant)

Arrange with Laboratory Haematology Registrar and ensure that they know they may be entered into a trial.

 

Cell surface marker analysis on bone marrow. Only send blood as well if there is a specific indication, e.g. dry tap

In addition to the standard surface markers done here, all possible AML19 patients require 2 tugs of 1 mL of the first 2 pulls to go onto EDTA (not transport medium), to be sent to Auckland.

 

Arrange with surface marker lab. (ext: 80917).

Due to the hypercellularity of bone marrow, especially at presentation, there is a high change of clotting within the EDTA tube if overfilled, affecting the flow MRD results.

Therefore, aspirate collection is recommended in this order:

  • 1–2 mL each in x2 EDTA tube for MRD flow at labplus (max 2 mL).
  • Aspirate slides.
  • 3–4 mL in EDTA for molecular oncology.
  • 1–2 mL each in x2 RPMI for local testing.

 

Cytogenetics and appropriate molecular biology on BM. Storage of DNA

Haematology Registrar will deal with BM samples, ensuring that both labs are aware if it is a potential AML10 Patient.

 

Consider whether cytogenetics needed on blood, e.g. if there is a dry tap

Blood 10 mL in heparin (may require more if WBC count very low)

Swabs

Microbiology-swabs from nostrils, throat, swabs of any infected lesions

Label forms ‘for bacterial and fungal cultures’ and ‘New Leukaemic’.

Radiology

Sinus CT

All patients

 

Chest X-Ray

All patients

Other

ECG

All patients

 

ECHO for LVEF

All patients, before they receive intensive chemotherapy. For further details of LVEF monitoring, see Cardiotoxicity and Cytotoxic Drugs in the Drug Usage section.

 

MSU, Sputum, Stool

According to clinical indications

 

Blood cultures

If clinically indicated.

 

CSF

Only in patients with suspicion of CNS disease at diagnosis and for all others at times of intrathecal treatment.

Send CSF to Haematology Lab for cell counts, "cytospin" and microscopic examination. If the term cytospin isn’t used, the sample will go to Cytology instead of the Haematology Lab.

Referrals

Dental assessment (special form) on all intensively treated patients.

 

 

 

 

Hickman line insertion, Psychologist assessment

All patients being treated intensively should be referred at the time of diagnosis for assessment. However, treatment may need to be delayed depending on the counts, etc.

 

 

 

 

Fertility Centre if appropriate.

See separate section on fertility in Red Book. These discussions would usually be undertaken by the consultant.

 

Social work assessment

All patients should be referred for a baseline assessment of their needs.

 

Hickman line insertion

Psychologist assessment

On an individual basis but many patients find very valuable.

 

OT, Physio, Social Worker, Dietitian, Wig specialist

Nurses to organise

About this Canterbury DHB document (4285):

Document Owner:

Peter Ganly (see Who's Who)

Issue Date:

October 2018

Next Review:

October 2020

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 4285