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Acute lymphocytic leukemia
From WikEM
Contents
Background
- Characterized by proliferation of immature lymphoblast( >20% in periphery)
- Less than 20% of acute leukemias in adults,
- Most common form in children (see also Leukemia (Peds))
- Highest incidence in 7th decade of life
Clinical Features
- Lymphocytosis, neutropenia, anemia, thrombocytopenia,
- Lymphadenopathy, hepatosplenomegaly
- CNS and testes involvement common
Differential Diagnosis
Acute Leukemia/Lymphoma
- Acute myeloid leukemia
- Acute lymphocytic leukemia
- Hodgkin's lymphoma
- Non-Hodgkin's lymphoma
Evaluation
- CXR
- CBC with peripheral smear
- Chem7, ca, mg, phos, Uric Acid, UA, LDH (to check for Tumor Lysis)
- LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen (to check for DIC)
- ESR, CRP
- Reticulocyte count in anemia
- Get extra purple top for flow cytometry, especially before transfusion
Treatment
- Aggressive IV hydration
- If febrile, complete cultures and broad spectrum antibiotics
- Manage Complications
- see DIC
- see Leukostasis
- see Tumor Lysis Syndrome
