Which clinical history findings are characteristic of pediatric acute lymphoblastic leukemia (ALL)?

Updated: Jan 03, 2019
  • Author: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Children with acute lymphoblastic leukemia (ALL) often present with signs and symptoms that reflect bone marrow infiltration and/or extramedullary disease. When leukemic blasts replace the bone marrow, patients present with signs of bone marrow failure, including anemia, thrombocytopenia, and neutropenia. In patients with B-precursor ALL, bone pain, arthritis, and limping may be presenting symptoms and in 5% of patients are the only symptoms, leading to delays in diagnosis. [10] Fevers, whether low- or high-grade, are common at presentation, but despite neutropenia, sepsis is rarely seen. Other common clinical manifestations include fatigue, pallor, petechiae, and bleeding. In addition, leukemic spread may manifest as lymphadenopathy and hepatosplenomegaly.

Mature-B ALL may be associated with extramedullary masses in the abdomen or head and neck and central nervous system (CNS) involvement.

In patients with T-lineage ALL, respiratory distress and stridor secondary to a mediastinal mass may be a presenting symptom.

Symptoms of CNS involvement, such as headache, vomiting, lethargy, and nuchal rigidity are rarely noted at initial diagnosis but are more common in T-lineage and mature B cell ALL. [1] Cranial nerve deficits are an important sign of CNS involvement. Testicular involvement at diagnosis is also rare; if present, it appears as unilateral painless testicular enlargement.


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