Splenic Sequestration Crisis

Acute leukaemia is malignant clonal proliferation of immature haematopoietic cells causing bone marrow failure and infiltration of tissues. Acute lymphoblastic leukaemia accounts for most childhood cases, while acute myeloid leukaemia is less common.

Bone marrow failure causes:

• Pallor and fatigue
• Fever or recurrent infection
• Petechiae, bruising or bleeding

Infiltration causes:

• Bone or joint pain
• Lymphadenopathy
• Hepatosplenomegaly
• Testicular enlargement
• CNS symptoms

A mediastinal mass may occur particularly with T cell ALL and can cause airway compromise.

• FBC may show anaemia, thrombocytopenia and abnormal white cell count.

• Blood film may show blasts, but absence of circulating blasts does not exclude leukaemia.

• Bone marrow aspirate and immunophenotyping confirm diagnosis.

• Cytogenetic and molecular studies establish prognostic and therapeutic subgroups.

• Check uric acid, potassium, phosphate, calcium, creatinine and LDH because tumour lysis may already be present.

• Refer urgently to paediatric haemato oncology.

• Stabilize infection, bleeding and metabolic abnormalities before definitive chemotherapy where possible.

• Suspected febrile neutropenia requires immediate broad spectrum IV antibiotics.

• Prevent tumour lysis with careful hydration and allopurinol or rasburicase according to risk.

• Avoid unnecessary corticosteroids before diagnostic marrow sampling because steroids can partially treat ALL and alter diagnostic findings.

• Transfuse red cells and platelets according to clinical need, with careful consideration of hyperleucocytosis.