Abstract
Objective: Acute leukemia is the most common type of malignancy in childhood. Fever, malaise, hepatosplenomegaly and lymphadenopathy are among the most common presentations of leukemia. It is of vital importance for the physician, who is the first to evaluate the patient, to comprehend/ understand about the presenting findings of acute leukemia for early diagnosis and treatment. We aimed to emphasize the significant clues which point to acute leukemia in childhood for non-hematologist physicians. Materials and Methods: All children aged 0-18 years who were diagnosed with acute leukemia in our clinic between May 2017 and February 2021 were included. The complaints, physical examination findings and blood test results of all patients diagnosed with acute leukemia at their admission were retrospectively analyzed. Results: The files of 62 children with acute leukemia were analyzed. The male/female ratio was 1.58, and the mean age was 6±4.93 years (min-max 1-17 years). The median time of onset of complaints was 15 days. The most common complaints were fatigue (85.5%), fever (51.1%) and leg pain (33.8%). The most common findings on physical examination were pallor (74.2%), hepatosplenomegaly(43.1%) and lymphadenopathy (37.1%). At admission, all of the patients had abnormalities of complete blood counts in at least one series. 79% of the patients had anemia (hb<10g/dl), 69.4% had thrombocytopenia (<100000/mm3 ) and 67.7% of the patients had neutropenia (<1500/mm3 ). The most common abnormality in the biochemical tests was elevated LDH values (median LDH: 576IU/L). Conclusion: Recognizing the most common presentation findings of childhood leukemia by the first physician is an important step for early diagnosis and treatment in childhood leukemia.
Keywords
Leukemia children symptoms anemia neutropenia early diagnosis
References
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- 2. Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, et al. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med 2009;360(26):2730-41. google scholar
- 3. Kebudi R. Pediatric oncology in Turkey. J Pediatr Hematol Oncol 2012;34:12-4. google scholar
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- 8. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med 2011;364(19):1844-54. google scholar
- 9. Pulte D, Gondos A, Brenner H. Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century. Blood 2009;113:1408-11. google scholar
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- 14. Bernbeck B, Wüller D, JanRen G, Wessalowski R, Göbel U, Schneider T, et al. Symptoms of Childhood Acute Lymphoblastic Leukemia: Red Flags to Recognize Leukemia in Daily Practice. Klin Padiatr 2009;221:369-73. google scholar
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Abstract
Amaç: Çocukluk çağında en sık görülen kanserleri akut lösemiler oluşturmaktadır. Lösemili çocukların en sık başvuru nedenleri arasında ateş, halsizlik, hepatosplenomegali ve lenfadenopati gelmektedir. Akut löseminin geliş bulgularının ilk değerlendiren hekim tarafından bilinmesi erken tanı ve tedavi için hayati önem taşımaktadır. Bu çalışmada hematolog olmayan tüm hekimler için çocukluk çağında akut lösemiden şüphelenilmesi gereken durumların ipuçlarını ortaya çıkarmak amaçlanmıştır. Gereç ve Yöntem: Hastanemizin Çocuk Hematoloji ve Onkoloji kliniğinde Mayıs 2017- Şubat 2021 tarihleri arasında akut lösemi tanısı alan 0-18 yaş arası tüm çocuklar dahil edildi. Akut lösemi tanılı tüm hastaların ilk geliş şikayetleri, fizik muayene bulguları ve laboratuvar sonuçları hastaların dosyalarından retrospektif olarak incelendi. Bulgular: Akut lösemi tanısı konulan toplam 62 çocuk hastanın dosyası incelendi. Erkek/Kız oranı: 1.58, ortalama tanı yaşı: 6±4,93 yıl (min-max 1-17 yaş) idi. Şikayetlerin başlama süresi ortanca 15 gün olarak bulundu. En sık görülen şikayetler: halsizlik (%85,5), ateş (%51,1), bacak ağrısı (%33,8), karın ağrısı (%22,6) ve karın şişliği (%21) idi. Fizik muayene bulgularında en sık solukluk (%74,2), hepatosplenomegali (%43,1) ve lenfadenopati (%37,1) saptandı. Tüm hastaların tam kan sayımında en az bir seride anormallik mevcuttu. Hastaların başvuru anındaki tam kan sayımlarında %79’unda anemi (hb<10g/dl), %69,4’ünde trombositopeni (<100000/ mm3 ), %67,7’sinde nötropeni (<1500/mm3 ), %37,1’inde lökositoz (>20000/ mm3 ), %25,8’inde lökopeni(<4000/mm3 ) saptandı. Eş zamanlı bakılan biyokimyasal tetkiklerinde en sık görülen anormallik LDH değerlerinde yükseklik (ortanca LDH: 576 IU/L) idi. Sonuç: Çocukluk çağı lösemilerinin en sık başvuru bulgularının hastayı ilk gören hekim tarafından bilinmesi hastanın vakit kaybetmeden tanı ve tedaviye ulaşmasını sağlayacaktır.
References
- 1. Clarke RT, Bruel A, Bankhead C,Mitchell CD, Phillips B, Thompson MJ. Clinical presentation of childhood leukaemia: a systematic review and meta-analysis. Arch Dis Child 2016;101:894-901. google scholar
- 2. Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, et al. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med 2009;360(26):2730-41. google scholar
- 3. Kebudi R. Pediatric oncology in Turkey. J Pediatr Hematol Oncol 2012;34:12-4. google scholar
- 4. Kutluk T, Yesilipek MA. Pediatric Cancer Registry in Turkey (Turkish Pediatric Oncology Group & Turkish Pediatric Hematology Association). DOI: 10.1200/jgo.18.25100 Journal of Global Oncology 2018; vol 4, Sup2. google scholar
- 5. Malard F, Mohty M. Acute lymphoblastic leukaemia. Lancet 2020;395:1146-62. google scholar
- 6. Feltbower RG, Lewis IJ, Picton S, Richards M, Glaser AW, Kinsey SE, et al. Diagnosing childhood cancer in primary care—a realistic expectation? Br J Cancer 2004;90:1882-4. google scholar
- 7. Mitchell C, Hall G, Clarke RT. Acute leukaemia in children: diagnosis and management. BMJ 2009;338:b2285. google scholar
- 8. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med 2011;364(19):1844-54. google scholar
- 9. Pulte D, Gondos A, Brenner H. Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century. Blood 2009;113:1408-11. google scholar
- 10. Hutter JJ. Childhood leukemia. Pediatrics Rev 2010;31:234-41. google scholar
- 11. Hunger SP. Acute lymphoblastic leukemia in children. N Eng J Med 2015;373:1541-52. google scholar
- 12. Metayer C, Milne E, Clavel J, Infante-Rivard C, Petridou E, Taylor M, et al. The Childhood Leukemia International Consortium. Cancer Epidemiol 2013;37(3):336-47. google scholar
- 13. Seth R, Singh A. Leukemias in Children. Indian J Pediatr 2015;82(9):817-24. google scholar
- 14. Bernbeck B, Wüller D, JanRen G, Wessalowski R, Göbel U, Schneider T, et al. Symptoms of Childhood Acute Lymphoblastic Leukemia: Red Flags to Recognize Leukemia in Daily Practice. Klin Padiatr 2009;221:369-73. google scholar
- 15. Llano OG. The complete blood count in the early diagnosis of acute leukemia in children. Medicina Universitaria 2017;18:216-8. google scholar
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Paediatrics |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 9, 2022 |
| Published in Issue | Year 2022 Volume: 22 Issue: 2 |
