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Rapid Precision Medicine

Mar 04, 2019

Case study from John Postley, MD FACP

Procalcitonin levels is a helpful marker to elucidate bacterial infections. A patient who recently had radiation treatment for cancer, came in for the evaluation of a cough. A chest x-ray done in the office after a clinical evaluation revealed increased markings suggestive of either a pneumonia or inflammation called pneumonitis. Laboratory evaluation including a procalcitonin revealed that the inflammation noted on the chest x-ray was probably not due to a bacterial infection. The patient was diagnosed with a localized bout of pneumonitis from the recent radiation. Having a full complement of immediately accessible radiology studies, including chest xray,  the BioFire viral analyzer for respiratory and GI pathogens, and a state of the art, in-house laboratory to do stat labs including complete blood counts, and procalcitonin levels was invaluable in helping establish a precision diagnosis. 

 

Case study from Jahangir Rahman, MD FACP

A diagnosis of acute leukemia in a woman with nose bleeding and bleeding from her gums:  A woman presented recently with a two week history of new onset bleeding from her nose, and bleeding from her gums. A dentist evaluation did not come up with a diagnosis. The patient presented to our office with this history and small red capillary bleeding called petechiae on the legs on exam. Immediate laboratory testing done in-house with results in ten minutes, showed a very low white blood cell count, and a very low platelet count, and anemia consistent with an acute leukemia. The leukemia team at New York-Presbyterian Hospital was contacted to initiate immediate treatment. The chief of the leukemia service, Dr Gail Roboz, who was in Japan at the time, mobilized the team across the world to begin the diagnosis and management. A diagnosis of acute promyelocytic leukemia, or APL was diagnosed that evening. The patient was immediately started on treatment with all-trans Retinoic acid, and arsenic. The cure rate with this previously lethal diagnosis is now over 95%. Most of the deaths with this illness happen before the diagnosis is made usually due to severe intracranial or brain bleeding that happens spontaneously due to the low platelet counts and white blood cell count. Having our in-house laboratory available for immediate diagnosis was crucial in saving this patient with acute myeloid leukemia. Having access to world class subspecialists at New York Presbyterian at Columbia and Cornell Universities is a feature of our practice here at New York Physicians.