• The patient may present with weakness, malaise, bleeding, and weight loss.

• Neutropenic patients are often febrile and highly susceptible to infection.

• Anemia usually presents as pallor, tiredness, and general fatigue.

• Patients with thrombocytopenia usually present with bruising, petechiae, and ec-chymosis.

• Patients often present with bone pain secondary to expansion of the marrow cavity from leukemic infiltration.

• CNS involvement is common at diagnosis. Signs

• Temperature may be elevated secondary to an infection associated with a low WBC.

• Petechiae and bleeding are indicative of thrombocytopenia.

• Patients may present with organ involvement, such as peripheral adenopathy, hepatomegaly, and splenomegaly.

• T-lineage ALL may present with a mediastinal mass. Laboratory Tests

• CBC with differential is performed.

• The anemia is usually normochromic and normocytic. Approximately 50% of children present with platelet counts of less than 50 x 103/mm3 (50 x 109/L). The WBC

may be normal, decreased, or high. About 20% of patients have WBCs over 100 x 103/mm (100

x 109/L), which places them at risk for leukostasis.

• Uric acid is increased in approximately 50% of patients secondary to rapid cellular turnover.

• Electrolytes: Potassium and phosphorus often are elevated. Calcium usually is low.

• Coagulation disorders: Elevated prothrombin time, partial thromboplastin time, D-dimers; hypofibrinogenemia.

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