Lymph node biopsy

Consider pathology review.

History and physical examination

History to document “B” symptoms and any symptoms suggestive of possible sites of involvement.

Examination to detect lymphadenopathy, enlargement of liver or spleen, skin involvement, tumour masses, CNS involvement.

Blood tests

CBCD, blood film, reticulocytes, ESR.

3 x 5 mL EDTA mauve top, 1 x 5 mL plain.

ONCO profile, Ca++, PO₄, urate, AST, GGT and LDH, SPE, immunoglobulin levels, thyroid function test, beta-2 microglobulin, CRP

1 x 5 mL heparin, 1 x 5 mL plain.

Virology serology, HbSAg, HCV, herpes simplex/zoster, CMV. HIV - test requires patient permission.

1 x 5 mL plain request long term storage.

HLA typing if allografting is a possibility.

Contact SCT Coordinator. 4 x 10 mL CPDA (yellow top), 1 x 10 mL plain, 1 x 5 mL EDTA

Bone marrow

Bone marrow aspirate and trephine, immunophenotyping. Discuss with Consultant the need for cell markers, cytogenetics and DNA analysis.

Arrange with laboratory registrar.

Radiology

CXR, CT of neck, chest, abdomen and pelvis. Consider CT sinuses

CSF

Perform if neurological symptoms or signs or high risk of CNS involvement

Cell count, microscopy ± flow cytometry

Sample to Cell Markers lab

Microbiology

Swabs from nostrils, throat, perineum and groin labelled “for Staph aureus carriage” (and MRSA if appropriate). Swab any infected lesion ± sputum. Blood cultures if febrile.

Send to Microbiology.

Other

ECG, MSU, ECHO.

Referrals

• Fertility Centre
• Dental assessment – use the CDHB Dental Referral Form (fax to 80246 or email to oralhealthcentre@cdhb.health.nz).
• Is a central venous line required? If so, what type?
• Are irradiated blood products indicated?
• Occupational therapy, social work, physiotherapist, dietitian, wig specialist and psychologist referrals are all likely to be needed.
• Sperm or ovarian banking may be required.