Table 14-1 shows the common clinical and laboratory presenting features of ALL.
General Systemic Effects
Hematologic Effects Arising from Bone Marrow Invasion
1. Anemia—causing pallor, fatigability, tachycardia, dyspnea, and sometimes congestive heart failure
2. Neutropenia—causing fever, ulceration of buccal mucosa, and infection
3. Thrombocytopenia—causing petechiae, purpura, easy bruisability, bleeding from mucous membrane, and sometimes internal bleeding (e.g., intracranial hemorrhage)
4. One to 2% of patients present initially with pancytopenia and may be erroneously diagnosed as having aplastic anemia or bone marrow failure (represents 5% of acquired aplastic anemia) and ultimately develop acute leukemia. In these cases the illness is characterized by:
Pancytopenia or single cytopenia Hypocellular bone marrow No hepatosplenomegaly
Diagnosis of leukemia 1-9 months after onset of symptoms.
The treatment consists of supportive transfusions initially and specific antileukemic chemotherapy, when leukemia is diagnosed
Table 14-1. Clinical and Laboratory Features at Diagnosis in Children with Acute Lymphoblastic Leukemia
Clinical and laboratory findings
Percentage of patients
Bleeding (e.g., petechiae or purpura) Bone pain Lymphadenopathy Splenomegaly Hepatosplenomegaly Laboratory features Leukocyte count (mm3) <10,000 10,000-49,000 >50,000 Hemoglobin (g/dL) <7.0 7.0-11.0 >11.0
Platelet count (mm3) <20,000 20,000-99,000 >100,000 Lymphoblast morphology L1 L2 L3
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