Leukemia (peds)

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  • Most common cancer in children (33% of all malignancies)
  • ALL
    • 3/4 of pediatric leukemias
    • 5-year survival 75%-80%
    • Peak incidence 3-5yr old
  • AML
    • 1/5 of pediatric leukemias
    • Worse prognosis
    • More complications (more intense chemo treatment required)

Clinical Features

  • Signs/symptoms due to bone marrow infiltration and failure
    • Pallor, fatigue, easy bleeding, fever, infection
    • Bone/joint pain
    • Hepatomegaly or splenomegaly
  • Hyperleukocytosis
    • Clinically significant when WBC > 200K in AML, >300K in ALL
    • Cerebral circulation: headache, altered mental status, visual changes, seizure, CVA
    • Pulmonary circulation: shortness of breath, hypoxemia

Differential Diagnosis

Leukemias will often involve >1 cell line; other conditions restricted to single line

  • Aplastic anemia
  • Iron deficiency anemia
  • Viral infection (EBV, CMV, Parvo)
  • Immune thrombocytopenia
  • Rheumatologic diseases


  • CBC
    • If suggestive of leukemia also order:
      • Chemistry, Ca, Phos, Mg, Uric acid, LFT, LDH, coags, T+S, CXR


  • Transfusion
    • Options
      • Irradiated: for very immunosuppressed (to prevent graft vs host)
      • Leukocyte-reduced: for patients likely to receive multiple RBC or platelets in future
      • CMV seronegative: for <1yr old, if might need bone marrow transplant in future
    • Anemia
      • 10 cc/kg of pRBCs raises hemoglobin by 3 gm/dL
      • Raise hemoglobin to >8
    • Thrombocytopenia
    • 0.1 unit/kg results in 30-50K increase in platelet count
    • Risk of spontaneous ICH is extremely low until platelets <5K
    • Transfuse if:
      • Asymptomatic with platelets <10K
      • Invasive procedures require platelets >50K
  • Hyperleukocytosis
    • Aggressive IV hydration
    • Urinary alkalinization (pH 7-7.5)
    • Allopurinol (for Tumor Lysis Syndrome (TLS))
    • Avoid diuretics and pRBC transfusion (platelets ok)
    • Give platelets if <20K
    • Leukapheresis

See Also