Leukemia (peds) - Revision history

Ostermayer at 17:20, 17 January 2026

2026-01-17T17:20:43Z

← Older revision		Revision as of 17:20, 17 January 2026
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	{{~~Peds top~~}} ~~[[leukemia]]~~		{{PediatricPage\|leukemia}}
	==Background==		==Background==
	*Most common cancer in children (33% of all malignancies)		*Most common cancer in children (33% of all malignancies)

SMReel: /* Presentation */

2022-04-18T21:56:27Z

Presentation

← Older revision		Revision as of 21:56, 18 April 2022
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	===Presentation===		===Presentation===
	*Hepatomegaly and/or splenomegaly with weight loss, abdominal ~~dissension~~ or abdominal pain		*Hepatomegaly and/or splenomegaly with weight loss, abdominal distension or abdominal pain
	*Lymphadenopathy		*Lymphadenopathy
	*Fever		*Fever

SMReel: /* Clinical Features */

2022-04-15T17:26:54Z

Clinical Features

← Older revision		Revision as of 17:26, 15 April 2022
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	==Background==		==Background==
	*Most common cancer in children (33% of all malignancies)		*Most common cancer in children (33% of all malignancies)
			*Most without cause but increased incidence with paternal age, maternal fetal loss, higher birthweight, familial clusters, and some genetic syndromes (Down syndrome)

	===[[acute lymphocytic leukemia\|ALL]]===		===[[acute lymphocytic leukemia\|ALL]]===
	*3/4 of pediatric leukemias		*3/4 of pediatric leukemias
	*5-year survival 75%-80%		*5-year survival 75%-80%
	*Peak incidence 3-5yr old		*Peak incidence 2-5yr old
			*Usually B lineage

	===[[AML]]===		===[[AML]]===
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	==Clinical Features==		==Clinical Features==

			===Presentation===
			*Hepatomegaly and/or splenomegaly with weight loss, abdominal dissension or abdominal pain
			*Lymphadenopathy
			*Fever
			*Bleeding (petechiae, purpura), low platelet count, anemia
			*MSK pain, limp, refusal to bear weight
			*Larger anterior mediastinal mass could cause SVC syndrome

	===Bone marrow infiltration and failure===		===Bone marrow infiltration and failure===
	*Pallor, [[fatigue]], easy bleeding, [[fever]], infection		*Pallor, [[fatigue]], easy bleeding, [[fever]], infection
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	**[[Stem cell transplant complications]]		**[[Stem cell transplant complications]]
	**Catheter-related complications		**Catheter-related complications
	**Tunnel infection		***Tunnel infection
	***Exit site infection		***Exit site infection
	***CVC obstruction (intraluminal or catheter tip thrombosis)		***CVC obstruction (intraluminal or catheter tip thrombosis)
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	*[[Aplastic anemia]]		*[[Aplastic anemia]]
	*Iron deficiency [[anemia]]		*Iron deficiency [[anemia]]
	*Viral infection ([[EBV]], [[CMV]], [[parvovirus B19\|Parvo]])		*Viral infection ([[EBV]], [[CMV]], [[parvovirus B19\|Parvo]]), [[HIV]]
	*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:
			***Review of peripheral smear
	***Chemistry, Ca, Phos, Mg, Uric acid, [[LFTs]], LDH, coags, T+S, UCG (if applicable)		***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]]to look for mediastinal mass
	***Consider [[DIC]] labs		***Consider [[DIC]] labs, coag studies

	==Management==		==Management==
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	==Disposition==		==Disposition==
	*~~admit~~		*Admit for further workup including bone marrow biopsy and LP

	==See Also==		==See Also==

Rossdonaldson1 at 23:31, 28 November 2019

2019-11-28T23:31:21Z

← Older revision		Revision as of 23:31, 28 November 2019
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	~~''This page is for pediatric patients. For adults, see~~ [[leukemia]]''		{{Peds top}} [[leukemia]]
	==Background==		==Background==
	*Most common cancer in children (33% of all malignancies)		*Most common cancer in children (33% of all malignancies)

ClaireLewis at 01:31, 1 October 2019

2019-10-01T01:31:43Z

← Older revision		Revision as of 01:31, 1 October 2019
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			''This page is for pediatric patients. For adults, see [[leukemia]]''
	==Background==		==Background==
	*Most common cancer in children (33% of all malignancies)		*Most common cancer in children (33% of all malignancies)

	===ALL===		===[[acute lymphocytic leukemia\|ALL]]===
	*3/4 of pediatric leukemias		*3/4 of pediatric leukemias
	*5-year survival 75%-80%		*5-year survival 75%-80%
	*Peak incidence 3-5yr old		*Peak incidence 3-5yr old

	===AML===		===[[AML]]===
	*1/5 of pediatric leukemias		*1/5 of pediatric leukemias
	*Worse prognosis		*Worse prognosis
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	*Cerebral circulation: [[headache]], [[altered mental status]], [[visual disturbances]], [[seizure]], [[CVA]]		*Cerebral circulation: [[headache]], [[altered mental status]], [[visual disturbances]], [[seizure]], [[CVA]]
	*Pulmonary circulation: [[shortness of breath]], [[hypoxemia]]		*Pulmonary circulation: [[shortness of breath]], [[hypoxemia]]

			===Complications===
			*[[Tumor lysis syndrome]]
			*[[Neutropenic fever]], [[Sepsis]], overall increased risk of [[infection]]
			**[[Neutropenic enterocolitis (typhlitis)]]
			*[[Leukostasis and hyperleukocytosis]]
			*[[Hyperviscosity syndrome]]
			*[[Thromboembolism]]
			*Treatment-related complications
			**Chemotherapy-induced [[nausea and vomiting]]
			**[[Cytokine release syndrome]]
			**Chemotherapeutic drug extravasation
			**[[Differentiation syndrome]] ([[retinoic acid syndrome]]) in APML
			**[[Stem cell transplant complications]]
			**Catheter-related complications
			**Tunnel infection
			***Exit site infection
			***CVC obstruction (intraluminal or catheter tip thrombosis)
			***Catheter-related venous thrombosis
			***Fracture of catheter lumen

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[Aplastic anemia]]		*[[Aplastic anemia]]
	*Iron deficiency [[anemia]]		*Iron deficiency [[anemia]]
	*Viral infection ([[EBV]], [[CMV]], Parvo)		*Viral infection ([[EBV]], [[CMV]], [[parvovirus B19\|Parvo]])
	*Immune [[thrombocytopenia]]		*Immune [[thrombocytopenia]]
	*Rheumatologic diseases		*Rheumatologic diseases
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	***Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster		***Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster
	***[[CXR]]		***[[CXR]]
			***Consider [[DIC]] labs

	==Management==		==Management==

ClaireLewis: /* Management */

2019-09-15T01:06:18Z

Management

← Older revision		Revision as of 01:06, 15 September 2019
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	***Invasive procedures require platelets >50K		***Invasive procedures require platelets >50K

	===[[Hyperleukocytosis]]===		===[[Leukostasis and Hyperleukocytosis]]===
	*Aggressive IV hydration		*Aggressive IV hydration
	*Urinary alkalinization (pH 7-7.5)		*Urinary alkalinization (pH 7-7.5)

ClaireLewis: /* See Also */

2019-09-15T01:05:44Z

ClaireLewis: /* Hyperleukocytosis */

2019-08-30T22:51:59Z

Hyperleukocytosis

← Older revision		Revision as of 22:51, 30 August 2019
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	===[[Leukostasis and hyperleukocytosis\|Hyperleukocytosis]]===		===[[Leukostasis and hyperleukocytosis\|Hyperleukocytosis]]===
	*Clinically significant when WBC > 200K in AML, >300K in ALL		*Clinically significant when WBC > 200K in AML, >300K in ALL
	*Cerebral circulation: [[headache]], [[altered mental status]], [[visual ~~changes~~]], [[seizure]], [[CVA]]		*Cerebral circulation: [[headache]], [[altered mental status]], [[visual disturbances]], [[seizure]], [[CVA]]
	*Pulmonary circulation: [[shortness of breath]], [[hypoxemia]]		*Pulmonary circulation: [[shortness of breath]], [[hypoxemia]]

ClaireLewis at 22:51, 30 August 2019

2019-08-30T22:51:32Z

← Older revision		Revision as of 22:51, 30 August 2019
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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/~~joint pain~~		*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, ~~LFT~~, LDH, coags, T+S, UCG (if applicable)		***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==

Lisayee25: /* Hyperleukocytosis */

2018-02-09T23:16:32Z

Hyperleukocytosis

← Older revision		Revision as of 23:16, 9 February 2018
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	*Hepatomegaly or splenomegaly		*Hepatomegaly or splenomegaly

	===Hyperleukocytosis===		===[[Leukostasis and hyperleukocytosis\|Hyperleukocytosis]]===
	*Clinically significant when WBC > 200K in AML, >300K in ALL		*Clinically significant when WBC > 200K in AML, >300K in ALL
	*Cerebral circulation: [[headache]], [[altered mental status]], [[visual changes]], [[seizure]], [[CVA]]		*Cerebral circulation: [[headache]], [[altered mental status]], [[visual changes]], [[seizure]], [[CVA]]

← Older revision		Revision as of 01:05, 15 September 2019
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	==See Also==		==See Also==
	*[[~~oncologic~~ emergencies]]		*[[Oncologic emergencies]]
			*[[Leukemia]]

	==References==		==References==