Difference between revisions of "Leukemia (peds)"

(See Also)
(Management)
Line 38: Line 38:
  
 
==Management==
 
==Management==
*[[Transfusion]]
+
===[[Transfusion]]===
**Options
+
*Options
***Irradiated: for very immunosuppressed (to prevent graft vs host)
+
**Irradiated: for very immunosuppressed (to prevent graft vs host)
***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 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:
***Asymptomatic with platelets <10K
+
**Asymptomatic with platelets <10K
***Invasive procedures require platelets >50K
+
**Invasive procedures require platelets >50K
*Hyperleukocytosis
+
 
**Aggressive IV hydration
+
===Hyperleukocytosis===
**Urinary alkalinization (pH 7-7.5)
+
*Aggressive IV hydration
**[[Allopurinol]] (for [[Tumor Lysis Syndrome (TLS)]])
+
*Urinary alkalinization (pH 7-7.5)
**Avoid diuretics and pRBC transfusion (platelets ok)
+
*[[Allopurinol]] (for [[Tumor Lysis Syndrome (TLS)]])
**Give platelets if <20K
+
*Avoid diuretics and pRBC transfusion (platelets ok)
**Leukapheresis
+
*Give platelets if <20K
 +
*Leukapheresis
  
 
==Disposition==
 
==Disposition==

Revision as of 05:03, 24 August 2017

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

  • 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

Evaluation[1]

  • CBC with manual differential
    • If suggestive of leukemia also order:
      • Chemistry, Ca, Phos, Mg, Uric acid, LFT, LDH, coags, T+S, UCG (if applicable)
      • Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster
      • CXR

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 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

See Also

References

  1. Horton TM and Steuber CP. Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children and adolescents. UpToDate.