Diagnosis and management of neonatal leukaemia

Congenital Leukemia Presenting as Fever in a Neonate

“…Hepatosplenomegaly is one of the most frequently encountered signs on physical examination, being noted in 80% of cases (10). Splenomegaly is present in 74% of cases (11).…”

“…Splenomegaly is present in 74% of cases (11). Lymphadenopathy is observed only one-quarter of the time (10). Patients can also present with other signs and symptoms commonly found in diseases of the bone marrow, including pallor, petechiae, ecchymosis, and abnormal bleeding.…”

“…Laboratory results revealed a white blood cell count of 370,000 k/mm3 with 86% blasts, hemoglobin 7.6 g/dL, and platelet count of 44,000 k/mm3. Leukemia was strongly suspected; however, further differential diagnosis of hyperleukocytosis includes transient myeloproliferative disease associated with Down syndrome, congenital infections, hemolytic diseases with leukamoid reaction, and other congenital neoplasms, such as neuroblastoma (10). Additional workup was initiated through consultation with pediatric oncology, including uric acid level, lactate dehydrogenase, basic metabolic panel, and ionized calcium to evaluate for tumor lysis syndrome.…”

“…The diagnosis of congenital leukemia depends on three major criteria: the presence of immature hematopoietic cells in peripheral blood and bone marrow, hematopoietic cell infiltration into nonhematopoietic tissue (ie, skin), and exclusion of other conditions in the differential diagnosis (9). This condition has an estimated incidence of <5 per 1 million births (10). We report a rare case of congenital leukemia presenting to the emergency department as pediatric fever.…”

Cancer in newborns and infants — generalities and therapeutic specificities

“…L'hyperleucocytose est fréquente. Le diagnostic, porté sur un examen du sang et de la moelle avec analyse cytologique, immunophéno-typique et moléculaire, devra toujours être confirmé dans un centre spécialisé, certaines réactions « pseudoleucémi-ques » post-infectieuses pouvant être trompeuses à cet âge [2,14]. Ces leucémies posent des difficultés tant cliniques qu'éthiques du fait de la gravité du pronostic et de la lourdeur et des séquelles potentielles induites par les traitements.…”