In hemodialysis patients, blood is accessed by the surgical attachment of an artery to a vein known as:

Choice A reason: Fasting blood glucose measures the blood sugar level after an individual has not eaten for at least 8 hours. While it provides a snapshot of current blood glucose levels, it does not reflect long-term blood glucose control.

Choice B reason: Urinalysis can detect the presence of glucose or ketones in the urine, which can indicate poor blood glucose control. However, it does not provide a direct measure of blood glucose levels over time and is not the best predictor of long-term control.

Choice C reason: Feasting (postprandial) blood glucose measures blood sugar levels after eating. It can indicate how well the body manages glucose after a meal but does not provide information about overall blood glucose control over the previous few months.

Choice D reason: Hemoglobin A1C, also known as HbA1c, measures the percentage of glycated hemoglobin in the blood. It reflects the average blood glucose levels over the past 2-3 months. This test is considered the best predictor of long-term blood glucose control because it provides a comprehensive view of blood sugar management over an extended period. The normal range for HbA1c is typically below 5.7% for individuals without diabetes.

Choice A reason: The primary distinction between ALL and AML is the type of cell that becomes cancerous. Acute Lymphocytic Leukemia (ALL) affects the lymphoid cell line. Lymphoid cells, or lymphocytes, are a type of white blood cell that plays a crucial role in the immune system, helping the body to fight infections. There are three types of lymphocytes: B cells, T cells, and natural killer (NK) cells. In ALL, the malignant transformation of these lymphocytes occurs, leading to an overproduction of immature lymphoid cells, or lymphoblasts. These lymphoblasts crowd out normal blood cells in the bone marrow, leading to symptoms such as anemia, susceptibility to infections, and easy bruising or bleeding.

Choice B reason: While it is true that ALL is more prevalent in children and AML is more common in adults, this age distribution is not the primary distinguishing feature between the two types of leukemia. ALL represents about 75% of pediatric leukemia cases, typically affecting children between 2 and 5 years old, while AML is more commonly diagnosed in adults, with the incidence increasing with age. However, both types can occur at any age, and the age of onset alone is not sufficient to distinguish between them. The differentiation based on cell type remains the most significant factor.

Choice C reason: Clinical manifestations of ALL and AML can be very similar because both involve the proliferation of immature white blood cells in the bone marrow, which disrupts normal blood cell production. Common symptoms include fatigue, frequent infections, fever, weight loss, easy bruising or bleeding, and bone pain. These symptoms result from the overproduction of immature leukemic cells and the subsequent suppression of normal hematopoiesis. Although there may be some differences in presentation based on the specific cell types involved, clinical manifestations are not the primary basis for differentiating between ALL and AML.

Choice D reason: The diagnostic tests used for ALL and AML are quite similar and typically include complete blood counts (CBC), bone marrow biopsy, and flow cytometry to identify the types of cells involved. Cytogenetic and molecular studies are also used to detect specific genetic abnormalities associated with each type of leukemia. While certain markers and genetic mutations may differ between ALL and AML, the overall approach to diagnosis involves similar testing methods. Therefore, the primary difference between the two leukemias lies in the cell type affected rather than the specific diagnostic tests used.