Leukemia (peds): Difference between revisions
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**More complications (more intense chemo tx required) | **More complications (more intense chemo tx required) | ||
== | ==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 | ||
== | ==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 | ||
== | ==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 | ||
== | ==See Also== | ||
==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
- Aplastic anemia
- Iron deficiency anemia
- Viral infection (EBV, CMV, Parvo)
- Immune thrombocytopenia
- Rheumatologic diseases
Diagnosis
- 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