Difference between revisions of "Leukemia (peds)"

m (Rossdonaldson1 moved page Leukemia (Peds) to Leukemia (peds))
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**More complications (more intense chemo tx required)
 
**More complications (more intense chemo tx required)
  
==Diagnosis==
+
==Clinical Features==
 
*Signs/symptoms due to bone marrow infiltration and failure
 
*Signs/symptoms due to bone marrow infiltration and failure
 
**Pallor, fatigue, easy bleeding, fever, infection
 
**Pallor, fatigue, easy bleeding, fever, infection
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**Pulmonary circulation: SOB, hypoxemia
 
**Pulmonary circulation: SOB, hypoxemia
  
==DDx==
+
==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
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#Rheumatologic diseases
 
#Rheumatologic diseases
  
==Work-Up==
+
==Diagnosis==
 
*CBC
 
*CBC
 
**If suggestive of leukemia also order:
 
**If suggestive of leukemia also order:
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==Treatment==
 
==Treatment==
*Transfusion
+
*[[Transfusion]]
 
**Options
 
**Options
 
***Irradiated: for very immunosuppressed (to prevent graft vs host)
 
***Irradiated: for very immunosuppressed (to prevent graft vs host)
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***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 Hb by 3 gm/dL
+
***10 cc/kg of [[pRBCs]] raises Hb by 3 gm/dL
 
***Raise Hb to >8
 
***Raise Hb to >8
**Thrombocytopenia
+
**[[Thrombocytopenia]]
 
**0.1 unit/kg results in 30-50K increase in plt count
 
**0.1 unit/kg results in 30-50K increase in plt count
 
**Risk of spontaneous ICH is extremely low until plt <5K
 
**Risk of spontaneous ICH is extremely low until plt <5K
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**Leukapheresis
 
**Leukapheresis
  
==Source==
+
==See Also==
Tintinalli
+
 
 +
==References==
  
 
[[Category:Peds]]
 
[[Category:Peds]]
 +
[[Category:Heme/Onc]]

Revision as of 14:58, 4 June 2015

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

Differential Diagnosis

  • Leukemias will often involve >1 cell line; other conditions restricted to single line
  1. Aplastic anemia
  2. Iron deficiency anemia
  3. Viral infection (EBV, CMV, Parvo)
  4. Immune thrombocytopenia
  5. Rheumatologic diseases

Diagnosis

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

Treatment

  • 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

See Also

References