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Q. Blood work of my 9-year-old son showed low Hb and acute lymphoblastic leukemia. Please help.

Answered by
Dr. Goswami Parth Rajendragiri
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 05, 2021

Hi doctor,

My son is 9 years old. He had flu and vomiting before a few days. He got better and back to normal after four days. He started complaining of tiredness even after doing normal activities, like going to second floor, writing his homework. He was sweating abnormally during night without sign of fever, and his body temperature was just normal.

After visiting the doctor, blood test show his Hb is below normal (6.0) and made a decision to stay at hospital and get blood. Please refer to the attached lab test report for the rest of lab test taken after that. Can you please advise what is the issue this patient might have? What are the other options? Is there a treatment for his case?

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Hello,

Welcome to icliniq.com.

Based on the provided history and reports (attachment removed to protect patient identity), it seems to be a hemolytic anemia case. The cause for hemolytic anemia should be searched. Dengue also should be ruled out by IgM ELISA test and NS1 antigen test. Spleen is also enlarged. So it is most probably it is hemolytic anemia. Elevated bilirubin also favors diagnosis.

He needs to visit the hematologist for a detailed physical examination, and accordingly, management can be planned.

In hemolytic anemia, RBC (red blood cells) are getting destructed. Autoimmune hemolytic anemia, G6PD deficiency, PNH, hemoglobinopathy, spherocytosis, etc., are some of the causes of hemolytic anemia. To increase hemoglobin and platelet, blood transfusion is needed.

I hope this helps.

Thank you doctor,

Is the probability of leukemia high in this case? Most of the CBC test shows very low counts for blood platelets. The kid showed better Hb (from 6 moved up to 8.1) and better blood platelets (from 9000 moved up to 26000) after getting his first blood. Does this give any indication that this might not be leukemia?

Currently, we saw a Hematologist, but he just said (leukemia) without deep explanation. We are reaching you in the hope to get a detailed answer. Is leukemia a fatal disease? What are the chances for this kid to survive?

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Hello,

Welcome back to icliniq.com.

There is a presence of low hemoglobin and low platelets. If the Hematologist does not find any cause for hemolytic anemia, then further workup should be done to exclude leukemia and myeloproliferative disorder. Bone marrow biopsy for your child can be planned for further workup.

Bone marrow biopsy is a gold standard test to exclude all blood cancer. Therefore, discuss with the Hematologist about planning for bone marrow biopsy.

In the attached report (attachment removed to protect patient identity), no abnormal malignant cells are present. So leukemia cannot be ruled out from the CBC (complete blood count) report only.

To exclude leukemia, I suggest bone marrow biopsy or flow cytometry like a higher investigation. There is the possibility of leukemia as well when bicytopenia present.

I hope this helps.

Thank you doctor,

Sorry, I thought I already included this test with the files I sent before. Please review and let me know if the test results help you be more specific for a reason for his situation? Is this kid had flu a few days before getting this situation support that it might be just a case caused by taking medicine to treat the flu? Is leukemia treatable in his situation?

#

Hello,

Welcome back to icliniq.com.

The attached report shows B cell acute lymphoblastic leukemia (attachment removed to protect patient identity).

So, your doctor is right. He is having ALL type of blood cancer. Therefore, I suggest he should be put on treatment for ALL. Prognosis is very good in children, and remission occurs in most cases. I am sorry, he has blood cancer. But do not worry. Prognosis and 10-year survival rate are good for this type of blood cancer.

I suggest you start treatment after a physical examination by a Hematologist.


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