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Download Group C – Acute Lymphocytic Leukemia
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1 Group C – Acute Lymphocytic Leukemia Diagnosis At first glance, the little boy’s symptoms point to some form of pediatric blood disease. A complete history and physical would help differentiate different types of blood diseases in children and help establish the onset of symptoms. It would be important to note exposure to chemicals, medications, family history of leukemia, and genetic or chromosomal abnormalities. Complete vital signs will help determine if fever is present (infection, inflammation) and whether signs of anemia may be due to acute hemorrhage (manifested by tachycardia and hypotension). Although we have been given evidence of an elevated white blood cell count, we do not have a differential. A differential will help us differentiate between AML (acute myelocytic and acute lymphocytic leukemia). Acute lymphocytic leukemia produces a large number of immature white blood cells (lymphocytes) which crowd out normal cells as they proliferate. These cells may be found in blood, bone marrow, lymph nodes, spleen and other organs. Cancer cells take over the normal parts of bone marrow, causing bone marrow failure. This causes a person with ALL to bleed more easily and be susceptible to infection (http://www.nlm.nih.gov/medlineplus/ency/article/000541.htm). A high T-cell count may be helpful in the diagnosis of immunodeficiency and lymphocytic diseases. T-lymphocytes act directly (cellular immunity), stimulate B-lymphocytes (helper T-cells), or suppress some B-lymphocyte functions (suppressor T-cells) (http://www.nlm.nih.gov/medlineplus/ency/article/0003516.htm). A B-cell leukemia/lymphoma panel looks for specific proteins on the surface of white blood cells. The proteins serve as markers for leukemia or lymphoma. This test may be performed when other tests, such as the blood smear mentioned, are abnormal. An elevated ESR also supports the picture of leukemia 2 (http://www.nlm.nih.gov/medlineplus/ency/article/0003518.htm). A PT/PTT may be indicated because of the increased tendency for bleeding. A chest X-ray may help to determine the presence of masses and/or enlarged lymph nodes and if enlarged lymph nodes are present, a biopsy should be performed. When a blood anomaly is present, a bone marrow aspiration or biopsy is the definitive test. A specimen from the iliac crest is usually obtained. Normal marrow contains less than 5% blasts, leukemic marrow usually has 60-100% blasts. Depending on the type of leukemia, there may be an elevation in eosinophils or basophils as well. The sample can have flowcytometry to determine the exact nature of the abnormal cell and cytogenic testing to determine the nature of a chromosomal or genetic abnormality (Florek, 2003). Other diagnostic tests may include a spinal tap to rule out CNS involvement. Observation for neurological changes like irritability, vomiting, and lethargy may indicate CNS infiltration. Continuous monitoring of the patient's physical condition for changes in temperature, new bleeding, increased bruising and blood in the stool is recommended (Florek, 2003). Certain types of leukemia have a poor outlook and others have a very good outlook. After completion of these tests, a definitive diagnosis can be made and the most appropriate treatment modality can be selected. References Child Care Nursing by Leona Florek, 2003, Prentice Hall http://www.nlm.nih.gov/medlineplus/ency/article/000541.htm http://www.nlm.nih.gov/medlineplus/ency/article/0003516.htm http://www.nlm.nih.gov/medlineplus/ency/article/0003518.htm
