Leukemia (peds): Difference between revisions
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**Options | **Options | ||
***Irradiated: for very immunosuppressed (to prevent graft vs host) | ***Irradiated: for very immunosuppressed (to prevent graft vs host) | ||
***Leukocyte-reduced: for patients likely to receive multiple RBC or | ***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 | ||
| Line 43: | Line 43: | ||
***Raise Hb to >8 | ***Raise Hb to >8 | ||
**[[Thrombocytopenia]] | **[[Thrombocytopenia]] | ||
**0.1 unit/kg results in 30-50K increase in | **0.1 unit/kg results in 30-50K increase in platelet count | ||
**Risk of spontaneous ICH is extremely low until | **Risk of spontaneous ICH is extremely low until platelets <5K | ||
**Transfuse if: | **Transfuse if: | ||
***Asymptomatic with plt <10K | ***Asymptomatic with plt <10K | ||
***Invasive procedures require | ***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) | ||
**Allopurinol (for [[Tumor Lysis Syndrome (TLS)]]) | **Allopurinol (for [[Tumor Lysis Syndrome (TLS)]]) | ||
**Avoid diuretics and pRBC transfusion ( | **Avoid diuretics and pRBC transfusion (platelets ok) | ||
**Give | **Give platelets if <20K | ||
**Leukapheresis | **Leukapheresis | ||
Revision as of 04:16, 15 July 2016
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 treatment 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, seizure, 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:
Management
- Transfusion
- Options
- Irradiated: for very immunosuppressed (to prevent graft vs host)
- 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
- 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 platelet count
- Risk of spontaneous ICH is extremely low until platelets <5K
- Transfuse if:
- Asymptomatic with plt <10K
- Invasive procedures require platelets >50K
- Options
- Hyperleukocytosis
- Aggressive IV hydration
- Urinary alkalinization (pH 7-7.5)
- Allopurinol (for Tumor Lysis Syndrome (TLS))
- Avoid diuretics and pRBC transfusion (platelets ok)
- Give platelets if <20K
- Leukapheresis