Сancer alertance in the practice of a primary care pediatrician: a retrospective analysis of the debut of acute leukemia in children

Relevance. Early diagnosis of acute leukemia (AL) in children is difficult due to the non-specificity of the symptoms of the onset of the disease, so knowledge of the probable symptoms will allow the doctor to diagnose leukemia earlier, thereby improving the prognosis for the patient.

The aim of the study – is to increase the oncological alertness of health workers providing primary health care to the child population, to update the “clinical and hematological portrait” (the most common clinical and hematological signs) of the manifestation of AL in children.

Materials and methods. The article presents data from a retrospective study of 39 cases of AL in children hospitalized from 2016 to 2022 in the oncohematology department of the Republican Children’s Clinical Hospital in Syktyvkar. Clinical and laboratory data of patients were evaluated in comparison with world literature data.

Results. The prevalence of AL in the Komi Republic was 3.15 per 100,000 children. The study group was dominated by children from urban areas (77 %), males (66.6 %), the median age was 5 years 3 months (min–max – 5 months – 17 years 9 months). At the onset of clinical manifestations, the most common were hyperplastic (97.4 %), infectious (79.4 %), intoxication (46.1 %) syndromes. In the structure of symptoms at the onset of the disease, fever (69.2 %), pain of various localizations (43.5 %), symptoms of local infections (20.5 %) prevailed. In the analysis of laboratory data, absolute neutropenia (76.9 %) was noted with 38.4 % of leukopenia cases. Also, the most frequent hematological changes were thrombocytopenia (87.1 %), anemia (76.9 %) and increased erythrocyte sedimentation rate (87.1 %). In our study, the data comparable with the results of published studies in the world literature were the age of the debut of AL in children, the average duration of symptoms before diagnosis and the leading clinical syndrome – hyperplastic, as well as fever. In the studied cohort, hepatomegaly and splenomegaly as symptoms of hyperplastic syndrome were noted in a greater number of cases, and among the hematological changes, leukopenia demonstrated predominant values, in contrast to the literature data. For the first time, priapism was noted as a symptom of AL in a child in the age group of 13 years.

Conclusion. Our analysis of clinical and hematological data of the debut of AL demonstrates pronounced clinical polymorphism, with a predominance of such symptoms as fever, pain, symptoms of local infectious processes and their combination. Emphasis is placed on the need to assess absolute values of differential white blood cell count in the routine practice of physicians providing primary health care to children. The results obtained draw the attention of primary care pediatricians to the importance of oncological alertness and early detection of AL.

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