Acute leukemia in children

Acute leukemia occurring in children more often chronic, begin gradually and the first time are uncertain objective symptoms and various patient complaints. Children become sluggish, naughty, bad sleep, lose their appetite, complaining of General weakness, easy fatigue, pain in the bones.
To set the exact time of occurrence of the first signs usually fails; sometimes the disease is detected accidentally made the analysis of blood. Initial subfebrile temperature fluctuations body in the future become more significant and more long lasting, growing pale skin and visible mucous membranes, appear isolated skin and subcutaneous hemorrhage, sometimes nosebleeds. Subjective complaints intensify appear shortness of breath, coughing, and other clear signs of discomfort. Especially children often complain of pain in the bones, usually in the lower extremities that is sometimes mistaken for rheumatism.
In the peripheral blood is growing phenomenon anemia, accelerated ROHE; the specific changes in leukocyte formula. Relatively early able to note disorders of the cardiovascular system, liver, kidneys, nervous system, metabolism, activity of enzymes of blood, etc. In the future, all the main clinical symptoms tend to rapid growth; the clinical picture in the foreground is characterized by a triad: acute anemia, progressively increasing, hemorrhagic phenomena and necrotic lesions of the mucous membranes of the oral cavity, pharynx and tonsils are usually more pronounced in children of school age (currently they happen less often that we think that is associated with more early start treatment). Relatively often, especially in children of the first years of life, are very painful subperiosteal leukemia infiltrates, often on the bones of the skull and ribs. The same infiltrates are on the skin (lymphodermia), in the salivary glands, the retina and the different departments of a CNS
Lymph nodes, especially in the corner of the lower jaw, neck, armpits and young, priuchayut, grow to accommodate the large bean or cherry (relatively rarely even more). Sometimes also increase intrathoracic and mesenteric lymph nodes. In other cases, on the contrary, hyperplasia of lymph nodes are very few. Enlarged lymph nodes are almost always speak against diagnosis of acute leukemia. Children often pronounced is the symptom of Mikulich - symmetric swollen tear and salivary glands as a result of losing their lymphoid tissue; sometimes with acute L. it is one of the first manifestations of the disease. In the midst of disease brisket and Shin, and sometimes other flat and long tubular bone is painful, especially when tapped and pressing. The spleen is enlarged, moderately dense, stands out from under a costal arch 1.5-2 cm; in some cases it is almost not increased. The liver is enlarged not always.
The digestion is disturbed, is developing rapidly declining food, although acidity and activity of enzymes of gastric contents are increased.
In urine detect protein, often urobilin, sometimes a few shaped items - erythrocytes, leukocytes and individual cylinders; always rich sediment crystals of uric acid and uric acid salts; less significant phosphaturia. The x-ray picture of the long bones almost always possible to note a strip of enlightenment, parallel epiphyseal line. Thus, for acute leukemia in children are quite characteristic of polymorphism main clinical symptoms and subjective symptoms.
In most cases the diagnosis L. usually can be established based on an assessment of leukocyte formula peripheral blood and confirmed by kilogrammes. The total number of leukocytes may be increased, stay within the age limit or even be reduced; relatively often can see a rather sudden change them from radiation to giperlakotsitos or Vice versa. Leykopenicheskih forms of acute leukemia observed in children younger ages, the leukemia shape is more senior. Children of all ages often can see subleikemical form with the number of white blood cells around 30 000 - 40 000. True leikemicakie form when peripheral blood is normal leukocyte formula and myelogram typical of acute leukemia, are rare. Such relationships are often in remission, caused by the treatment.
Picture of red blood in acute leukaemia in children is characterized by increasing deficiency; color indicator is about the unit. Anisoles, poikilocytosis, polychromasia, labor and megaloblasts almost always expressed more or less clearly. The number of reticulocytes ranges from 1 to 25 per thousand; osmotic resistance of erythrocytes in the normal range. The number of platelets is sharply reduced by the end of the disease. Retraction of a blood clot breaks. The duration of bleeding lengthened.
The most common form of acute leukemia in children include hemocytoblastoma (genocidalists) and microbiologistes (microbiologists). Much less have to see myeloblastic form (dominated by the typical myeloblaste) and microhemocirculation (dominated by microgametophyte, or as they are commonly known, the "bare kernel"). Acute forms of leukemia in children almost always occurs so-called leukemia hiatus, or leukemia abortion is the absence of intermediate forms between Mature and obviously immature forms of leukocytes. The relative content of lymphocytes always significantly reduced and does not exceed 5-10%; absolute their number when giperlakotsitos can be larger. The percentage of monocytes, eosinophils and basophils often within the normal range, in the initial stages of the disease is sometimes monocytosis. In the course of the disease leukocyte formula may change significantly.
The bone marrow for the most part is very monotonous part of the cell elements; most often in kilogramme prevail undifferentiated cells lymphoreticular, genocidally or microbially. Affects children of all ages, but most of preschool and primary school; in infants less often happens leukemia hiatus, but the disease is diagnosed earlier than the older.
Chloroma (acute Chlorakas) is observed in children is relatively rare, but more often than in adults; often affects boys. For chloroma characteristic parietalnae tumor green with extensive infiltrating growth. These tumors are most often localized in the bones of the skull (especially in an eye-socket), rarely in sternum, vertebrae or other bones. By tumors of the eye increases rapidly exophthalmos, there are strong headaches and neuralgic pain, often loses sight. In blood when chloroma observed changes characteristic of acute leukemia and subleikemical and leykopenicheskih forms of acute leukemia.
From acute forms with tumor growths in children, although rare, there is saralasaz characterized tumor growth in the area of thymus, lymph nodes in the mediastinum, neck, or other groups.
Currently, the possibility of congenital leukemia in infants is not in doubt. The pathogenesis of this form is not installed. Relatively often these children are congenital defects such as down's syndrome and other)that forces us to recognize the role of genetic factors. We cannot exclude the influence of external factors during pregnancy (ionizing exposure, x-ray examination of the abdomen of a pregnant). We must remember that the babies have leukemoid reactions in some diseases (sepsis, hemolytic disease and others).

Forecast in all forms of acute L. unfavorable. Sometimes all phenomena are growing very quickly, and the ill child dies within 2-3 weeks. With modern possibilities of treatment the duration of life of the patient is almost always possible to increase up to 1-1,5, rarely up to 2-3 years. For acute leukemia characterized remission, when not only restores the patient's health and comes with the seemingly complete recovery of the child (clinical remission), but fully normalized hemogram and myelogram. The duration of remission from 2-3 weeks to several months. Rapidity of its occurrence and duration depend largely on the treatment and maintenance therapy during remission. Sometimes random suppuration or acute infection (measles, scarlet fever, whooping cough) are the reason of occurrence of remission.
Treatment. From cytotoxic funds shows the assignment of the 6-mercaptopurine (from 2.5 to 5 mg per 1 kg of body weight per day in the reception 2-3). Leukopenia and trombopenia are not a contraindication to the appointment of the 6-mercaptopurine. Only the presence of hypoplastic in kilogramme is an indication for its abolition. Also use metotrexat; cytotoxic effect has antibiotic aurantis (Metamucil-C).
Necessarily prescribe hormonal corticosteroids (for 1 kg of body weight per day: prednisolone 2-5mg, triamcinolon 1,5-kg, dexamethasone 0,3-Oh,mg)under the protection of antibiotics, drugs and potassium. In severe and persistent anemia shown anabolic hormones. Necessary transfusion of blood, erythrocyte, leucocytes, trombotsitnoy estate. In patients with severe hemorrhagic syndrome transfusion swieciany blood. Mandatory appointment of antibiotics; treatment are under the control of repeated myelogram. Necrotic lesions in the shed irrigate solutions of antibiotics.
A careful patient care, nutritious food, rich in vitamins, as well as prevention of hemorrhagic phenomena. Prescribed drugs calcium, large doses of ascorbic acid, fresh lemon juice, honey infusion, vitamin P and so on, when bleeding - vitamin K. In remission mandatory appointment of maintenance doses of 6-mercaptopurine and corticosteroids.