poor


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Related to poor: House poor, Poor in spirit

poor

adjective Referring to a status wherein a person or persons lack enough money to live at a standard of comfort considered normal in a society. In 2009, 14.3% of Americans were poor; by race, 25% of Hispanics and Blacks are poor, 9% of Whites are poor.

leukemia

Hematology An uncommon–incidence, US 3.5/105/yr—malignant clonal expansion of myeloid or lymphoid cells characterized by an ↑ in circulating WBCs; leukemias may be an incidental finding when evaluating an unrelated clinical problem, or when the expansion compromises BM production of one or more cell lines causing anemia, thrombocytopenia, granulocytopenia; leukemias are divided by chronology–acute or chronic, by cell lineage–lymphoid, myeloid/myelocytic, monocytic or megakaryocytic and divided by stage of maturation or cell size Clinical BM infiltration by leukemia, resulting in anemia, thrombocytopenia, granulocytopenia, immune paralysis, ↓ B cells and CD4–helper T cells, ↑ CD8–suppressor T cells, infiltration and leukostasis, cranial nerve palsies, meningitis, lymphadenopathy, hepatosplenomegaly, testicular and cutaneous involvement, metabolic derangements–eg, ↑ Ca2+, K+, LD, ammonia, weight loss, less commonly, autoimmune hemolytic anemia, pallor and arthralgia Diagnosis Hx, physical exam, peripheral smear Management Chemotherapy, RT, BMT. See Accelerated leukemia, Acute leukemia, Acute lymphocytic leukemia, Acute myelocytic leukemia, Acute promyelocytic leukemia, Adult T-cell leukemia-lymphoma, Aleukemic leukemia, Biphenotypic leukemia, Central nervous system leukemia, Chemotherapy-induced leukemia, Chronic leukemia, Chronic lymphocytic leukemia, Chronic myelocytic leukemia, Chronic myelomonocytic leukemia, Congenital leukemia, Erythroleukemia, FAB classification, Hairy cell leukemia, Hand mirror cell leukemia, Herald state of leukemia, Mast cell leukemia, Megakaryoblastic leukemia, Multilineage leukemia, Plasma cell leukemia, Preleukemia, Prolymphocytic leukemia, Promyelocytic leukemia, Smoldering myeloid leukemia.
Leukemia Acute v. Chronic
Acute leukemia More common in children, 80% are ALL, often before age 10, peak at ages 3–7 in whites, ♂:♀ ratio, 1.3:1 Cell types Early pre-B cell 67%; pre-B cell 18%; B cell 1%; T cell 14%; 50-85% are cALLA positive–common acute lymphocytic leukemia antigen, CD10; 5% have Philadelphia chromosome Clinical ALL is more abrupt than AML, with petechial hemorrhage, bone and abdominal pain, headache and vomiting due to ↑ intracranial pressure, lymphadenopathy, splenomegaly, hepatomegaly Lab 70% have low-grade lymphocytosis–< 20 x 109 when diagnosed Evaluation Acute leukemia immunophenotypic profile Specimen EDTA–lavender top tube and sodium heparin–green top tube, peripheral blood smears Method of analysis Flow cytometry, immunofluorecesence Markers measured CD1, -2, -3, -4, -5, -7, -8, -10, -19. -20, -21, -33, -34, -56, megakaryocytic markers, HLA D/DR, kappa, lambda, TdT Management Protocols vary according to standard- or high-risk clinical features, and may include BMT
Chronic leukemia More common in adults/older children, often myelocytic; CML is Philadelphia chromosome positive; may occur < age 5 with myelomonocytosis, anemia, thrombocytopenia, lymphadenopathy; WBC count < 50 x 109, ≠ HbF, ≠ muraminidase; adult CML comprises 20% of all leukemias Clinical Gradual onset of fatigability, anorexia, splenomegaly; lymphadenopathy is uncommon Lab > 25 x 109/L leukemic cells in blood–often an absolute lymphocytosis of > 15 x 1010/L, < 10% blasts in BM, myeloid:erythroid ratio is 10-30:1, 90% of cases have low-to-absent leukocyte alkaline phosphatase and rarely also, ≠ vitamin B12 and B12-binding capacity Evaluation Chronic leukemia immunophenotype profile Specimen EDTA–lavender top tube and sodium heparin–green top tube, peripheral blood smears Method of analysis Flow cytometry, immunofluorescence Markers measured CD3, -5, -19, -20, -21, kappa, lambda Management see Chemotherapy, Induction Prognosis see Remission.
Leukemia–prognostic features
Acute lymphocytic leukemia
Good Age 2-10, CD10 positivity, hyperdiploid karyotype
Poor Age < 2; >10, B-cell phenotype, especially L2 phenotype by FAB classification, presence of chromosome translocations, CNS involvement, mediastinal masses, high initial WBC count
Acute myelocytic leukemia
Good Younger, presence of Auer rods, rapid therapeutic response
Poor Older, prior malignancy or therapy, multiple chromosome defects  
References in classic literature ?
"Witness, eternal God!" said George, kneeling on the grave of his poor friend; "oh, witness, that, from this hour, I will do what one man can to drive out this curse of slavery from my land!"
By a thousand eager declarations as to what he would do, when he went to live with his grandfather, he had shown the poor widow how little the idea of parting had cast him down.
So poor Amelia had been getting ready in silent misery for her son's departure, and had passed many and many a long solitary hour in making preparations for the end.
So then, all the love that Jesus showed to the poor is the same love that God has for us.
Poor Bessy had always been considered a naughty girl; she was conscious of it; if it was necessary to be very good, it was clear she must be in a bad way.
My poor niece was in a far worse state than that in which you now find her."
When, on fine autumn mornings, he found the countess sitting peacefully on a bench, beneath a poplar now yellowing, the poor lover would sit at her feet, looking into her eyes as long as she would let him, hoping ever that the light that was in them would become intelligent.
'This is another of the consequences of being poor! The idea of a girl with a really fine head of hair, having to do it by one flat candle and a few inches of looking-glass!'
Lavvy declining equally to repeat or to explain, Bella gradually lapsed over her hair-dressing into a soliloquy on the miseries of being poor, as exemplified in having nothing to put on, nothing to go out in, nothing to dress by, only a nasty box to dress at instead of a commodious dressing-table, and being obliged to take in suspicious lodgers.
These poor children think they are so much cleverer than their fathers and mothers."
It so happened that a fisherman had spread his net at the very place where poor Athanase had flung himself, believing that no one would ever find him.
Ev'n should I fall o'er the broken bridge passing, Or stray in the marshes, by false lights beguiled, Still will my Father, with promise and blessing, Take to His bosom the poor orphan child.