Question

question 73
1 pts
a 32 - year - old male patient is diagnosed with hodgkin lymphoma. initial lab work reveals a wbc of 20 109/l, hemoglobin of 10.1 gm/dl, a serum albumin of 3 g/dl, and lymphopenia of 0.5 109/l. staging studies identify stage iii disease. what is this patients prognostic score?
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Explanation:

To determine the prognostic score for Hodgkin lymphoma, we consider the International Prognostic Score (IPS) criteria. The IPS factors include:

• Age ≥ 45 years (this patient is 32 - no score)
• Male gender (score 1)
• Stage III or IV (score 1 for stage III)
• Serum albumin < 4 g/dL (score 1 as it is 3 g/dL)
• Hemoglobin < 10.5 g/dL (score 1 as it is 10.1 g/dL)
• WBC ≥ 15 × 10⁹/L (score 1 as it is 20 × 10⁹/L)
• Lymphopenia (lymphocytes < 0.6 × 10⁹/L or < 8% of WBC - score 1 as it is 0.5 × 10⁹/L)

Counting the scores: male (1) + stage III (1) + albumin (1) + hemoglobin (1) + WBC (1) + lymphopenia (1) = 6 factors. But wait, let's re - check.

Another way:

1. Male: 1 point
2. Stage III: 1 point
3. Albumin < 4 g/dL: 1 point
4. Hemoglobin < 10.5 g/dL: 1 point
5. WBC ≥ 15 × 10⁹/L: 1 point
6. Lymphopenia: 1 point

Total score = 6? No, wait the IPS for Hodgkin lymphoma:
The International Prognostic Score (IPS) for advanced Hodgkin lymphoma (stages III - IV) has 7 factors. But in this case:

• Male: 1
• Age ≥ 45: no (patient is 32)
• Stage III/IV: 1 (stage III)
• Albumin < 4: 1
• Hemoglobin < 10.5: 1
• WBC ≥ 15: 1
• Lymphopenia: 1

Count the number of positive factors:
Male (1) + stage III (1) + albumin (1) + hemoglobin (1) + WBC (1) + lymphopenia (1) = 6. But no, wait the formula is:
Each of the following factors is assigned 1 point:

• Age ≥ 45 years
• Male sex
• Stage IV
• Serum albumin < 4 g/dL
• Hemoglobin < 10.5 g/dL
• WBC ≥ 15 × 10⁹/L
• Lymphopenia (lymphocytes < 0.6 × 10⁹/L or < 8% of WBC)

In our case:

• Male: 1
• Stage III (not IV, but in some versions, stage III - IV are considered. Wait, no, the original IPS is for advanced (stages III - IV). But let's check each factor:
• Age: 32 < 45 (0)
• Sex: male (1)
• Stage: III (in IPS for advanced (III - IV), so stage is counted as 1 if III or IV)
• Albumin: 3 < 4 (1)
• Hemoglobin: 10.1 < 10.5 (1)
• WBC: 20 ≥ 15 (1)
• Lymphopenia: 0.5 < 0.6 (1)

Total score = 1 (male) + 1 (stage) + 1 (albumin) + 1 (hemoglobin) + 1 (WBC) + 1 (lymphopenia) = 6. But wait, no, the options are 2,3,4,5. Maybe a miscalculation.

Wait, another approach:
The International Prognostic Score (IPS) for advanced Hodgkin lymphoma:
Each of 7 factors (age ≥ 45, male, stage IV, albumin < 4, hemoglobin < 10.5, WBC ≥ 15, lymphopenia) gives 1 point.
In our case:

• Age: 32 (0)
• Male: 1
• Stage: III (in IPS for advanced (III - IV), stage is considered as 1 if III or IV)
• Albumin: 1
• Hemoglobin: 1
• WBC: 1
• Lymphopenia: 1

Total = 1 (male) + 1 (stage) + 1 (albumin) + 1 (hemoglobin) + 1 (WBC) + 1 (lymphopenia) = 6. But the options don't have 6. Wait, maybe the stage is mis - considered. Wait, no, some sources:
The IPS is as follows:

• Age ≥ 45: 1
• Male: 1
• Stage IV: 1 (not III)
• Albumin < 4: 1
• Hemoglobin < 10.5: 1
• WBC ≥ 15: 1
• Lymphopenia: 1

If stage is III (not IV), then stage is 0. Then:
Male (1) + albumin (1) + hemoglobin (1) + WBC (1) + lymphopenia (1) = 5

Answer:

5