Difference between revisions of "Leukemia (peds)"

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**Aggressive IV hydration
**Aggressive IV hydration
**Urinary alkalinization (pH 7-7.5)
**Urinary alkalinization (pH 7-7.5)
**Allopurinol (for [[Tumor Lysis Syndrome]])
**Allopurinol (for [[Tumor Lysis Syndrome (TLS)]])
**Avoid diuretics and pRBC transfusion (plts ok)
**Avoid diuretics and pRBC transfusion (plts ok)
**Give plts if <20K
**Give plts if <20K

Revision as of 22:32, 29 June 2011


  • 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 tx required)


  • 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: HA, AMS, visual changes, sz, CVA
    • Pulmonary circulation: SOB, hypoxemia


  • Leukemias will often involve >1 cell line, other conditions restricted to single one
  1. Aplastic anemia
  2. Iron deficiency anemia
  3. Viral infection (EBV, CMV, Parvo)
  4. Immune thrombocytopenia
  5. 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 pts likely to receive multiple RBC or plts in future
      • CMV seronegative: for <1yr old, if might need bone marrow transplant in future
    • Anemia
      • 10 cc/kg of pRBCs raises Hb by 3 gm/dL
      • Raise Hb to >8
    • Thrombocytopenia
    • 0.1 unit/kg results in 30-50K increase in plt count
    • Risk of spontaneous ICH is extremely low until plt <5K
    • Transfuse if:
      • Asymptomatic w/ plt <10K
      • Invasive procedures require plt >50K
  • Hyperleukocytosis
    • Aggressive IV hydration
    • Urinary alkalinization (pH 7-7.5)
    • Allopurinol (for Tumor Lysis Syndrome (TLS))
    • Avoid diuretics and pRBC transfusion (plts ok)
    • Give plts if <20K
    • Leukapheresis