Acute Leukaemia in Childhood

By Wyndham, Mike

This month, In the Picture highlights the different types of childhood leukaemia and the signs to look out for Cases on the increase

There are approximately 400 new cases of childhood leukaemia in the UK each year. 75% of these will be acute lymphoblastic leukaemia (ALL) and the rest acute myeloblastic leukaemia (AML). ALL tends to occur between the age of 1-5 years and AML may even develop in the first year of life. Children with certain genetic disorders are more at risk of developing leukaemia, for example, those with Li- Fraumeni syndrome and Down’s syndrome (15 times greater than the general population and more commonly AML).

Symptoms

The presenting symptoms reflect which part of the bone marrow production is affected. Anaemia may present with tiredness and a pale appearance. Reduction in white blood cells predisposes to infection: the child may have fever and symptoms relating to the lung, such as a cough or shortness of breath. Thrombocytopenia (platelet reduction) may present with spontaneous bruising, bleeding gums or nose bleeds.

Examination

Examination may reveal lymphadenopathy and hepatosplenomegaly. A check should be made for possible involvement of the nervous system. To confirm the diagnosis, standard full blood count and biochemistry should be carried out. A bone marrow examination (taken from the iliac crest of the pelvis) will help to decide what type of leukaemia is present. A lumbar puncture taking fluid from around the spinal cord should be examined for leukaemic cells and a chest x- ray to check for lyphadenopathy.

Treatment

Treatment of leukaemia includes chemotherapy and where there is involvement of the central nervous system, intrathecal chemotherapy (injection into the spinal fluid via a lumbar puncture). Bone marrow transplantation may be considered for high risk patients or where the disease has relapsed.

Mike Wyndham GP in Edgyvare, Middlesex and course organiser, Barnet GP Vocational Training Scheme

Copyright TG Scott & Son Ltd. Jul 2007

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