Leukemia (peds): Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===Bone marrow infiltration and failure=== | ===Bone marrow infiltration and failure=== | ||
*Pallor, fatigue, easy bleeding, [[fever]], infection | *Pallor, [[fatigue]], easy bleeding, [[fever]], infection | ||
*Bone/ | *Bone pain/[[arthralgia]] | ||
*Hepatomegaly or splenomegaly | *[[Hepatomegaly]] or splenomegaly | ||
===[[Leukostasis and hyperleukocytosis|Hyperleukocytosis]]=== | ===[[Leukostasis and hyperleukocytosis|Hyperleukocytosis]]=== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
''Leukemias will often involve >1 cell line; other conditions restricted to single line'' | ''Leukemias will often involve >1 cell line; other conditions restricted to single line'' | ||
*Aplastic anemia | *[[Aplastic anemia]] | ||
*Iron deficiency anemia | *Iron deficiency [[anemia]] | ||
*Viral infection (EBV, CMV, Parvo) | *Viral infection ([[EBV]], [[CMV]], Parvo) | ||
*Immune thrombocytopenia | *Immune [[thrombocytopenia]] | ||
*Rheumatologic diseases | *Rheumatologic diseases | ||
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*CBC with manual differential | *CBC with manual differential | ||
**If suggestive of leukemia also order: | **If suggestive of leukemia also order: | ||
***Chemistry, Ca, Phos, Mg, Uric acid, | ***Chemistry, Ca, Phos, Mg, Uric acid, [[LFTs]], LDH, coags, T+S, UCG (if applicable) | ||
***Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster | ***Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster | ||
***CXR | ***[[CXR]] | ||
==Management== | ==Management== | ||
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**Leukocyte-reduced: for patients likely to receive multiple RBC or platelets in future | **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 | **CMV seronegative: for <1yr old, if might need bone marrow transplant in future | ||
*Anemia | *[[Anemia]] | ||
**10 cc/kg of [[pRBCs]] raises hemoglobin by 3 gm/dL | **10 cc/kg of [[pRBCs]] raises hemoglobin by 3 gm/dL | ||
**Raise hemoglobin to >8 | **Raise hemoglobin to >8 | ||
*[[Thrombocytopenia]] | *[[Thrombocytopenia]] | ||
**0.1 unit/kg results in 30-50K increase in platelet count | **0.1 unit/kg [[platelets]] results in 30-50K increase in platelet count | ||
**Risk of spontaneous ICH is extremely low until platelets <5K | **Risk of spontaneous ICH is extremely low until platelets <5K | ||
**Transfuse if: | **Transfuse if: | ||
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***Invasive procedures require platelets >50K | ***Invasive procedures require platelets >50K | ||
===Hyperleukocytosis=== | ===[[Hyperleukocytosis]]=== | ||
*Aggressive IV hydration | *Aggressive IV hydration | ||
*Urinary alkalinization (pH 7-7.5) | *Urinary alkalinization (pH 7-7.5) | ||
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==Disposition== | ==Disposition== | ||
*admit | |||
==See Also== | ==See Also== | ||
*[[oncologic emergencies]] | |||
==References== | ==References== | ||
Revision as of 22:51, 30 August 2019
Background
- 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
Bone marrow infiltration and failure
- Pallor, fatigue, easy bleeding, fever, infection
- Bone pain/arthralgia
- 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
Evaluation[1]
- CBC with manual differential
Management
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 platelets 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
Disposition
- admit
See Also
References
- ↑ Horton TM and Steuber CP. Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children and adolescents. UpToDate.