Leukemia (peds): Difference between revisions
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Revision as of 14:57, 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)
Diagnosis
- 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
DDx
- 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
Work-Up
- CBC
- If suggestive of leukemia also order:
- Chemistry, Ca, Phos, Mg, Uric acid, LFT, LDH, coags, T+S, CXR
- If suggestive of leukemia also order:
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
- Options
- 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
Source
Tintinalli