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Pediatric Leukemia.

Pediatric Leukemia

Pediatric Leukemia is one of the most devastating forms of cancer today. This is not only because it is considered acute cancer 95% of the time, but also because it affects the most vulnerable amongst us--our children. Leukemia is a cancer that starts in young blood cells of the bone marrow. Leukemia usually starts in white blood cells but it is possible that it could start in other blood cells too. In fact, any blood-forming cell in bone marrow can become leukemia. About seventy-five percent of all acute leukemia seen in the pediatric population are known as "ALL" or acute lymphocytic (or lymphoblastic) leukemia.

Once a cell changes--becomes "rogue"--it no longer functions as normal. It tends to escape aptotic control and sometimes escapes the bone marrow vasculature. Leukemia cells may reproduce very quickly and live longer than they are supposed to live. This generally causes a build-up of "rogue" or bad cells which crowds out the healthy cells. Most of the time, leukemia cells tend to overflow and rapidly spill into the bloodstream where they travel to other parts of the body, continue to reproduce, affecting other bodily functions. The crossing of leukemic cells in the blood brain barrier causes adverse results to the patient and obviously, can have disastrous results. According to the Centers for Disease Control and Prevention, cancer kills more people every year than criminal activity and leukemia is the most common form of cancer in children and teens. That's why there is an incredible amount of research going on to finding a cure. There is a lot we are learning in cancer research every day and there is a lot more we still need to learn before we finally defeat this terrible affliction. Research on stem cell transplants and immunotherapy greatly helps to alleviate the painful course of treatment of leukemia.

Because leukemia begins in the bone marrow, symptoms often occur as problems with the bone marrow and the cells produced within. As leukemia cells crowd out healthy, blood-making cells, we may see a reduction in RBC (Red Blood Cell), WBC (White Blood Cell), and blood platelet count. Low RBC count (anemia) can cause the child to feel tired, weak, dizzy, have pale skin, feel cold or other symptoms. A reduction in WBC production usually causes fever and makes the child more prone to infections. Low blood platelet counts can cause nosebleeds or bleeding gums and easy bruising. These symptoms can become severe. A simple CBC test can determine if this is happening.

Leukemia cells may also invade other areas of the body, causing mild to severe symptoms including swollen lymph nodes, bone/joint discomfort, hepatomegaly or splenomegaly (which can lead to loss of ability to eat enough food, causing weight loss), swelling of the arms, face, neck, or upper chest, and may cause headaches, unexplained bruising, seizures, and other severe reactions as the central nervous system and other organs become infected.

If a child is suspected to have leukemia, samples of the child's blood and bone marrow must be collected and examined to confirm the diagnosis. A pediatric oncologist usually does these tests. If the results indicate that the child does have leukemia, other body tissues and cell specimens usually need to be examined to help determine the extent of the infection.

The first and most obvious tests are blood tests. These tests include CBC (Complete Blood Count) and the blood smear. With the CBC, the technician is looking for abnormality in the number of cells. In most cases, there are too many white blood cells and not enough red blood cells. The technician performs a blood smear to check for deformities or abnormalities in the cells.

The next tests are the bone marrow aspiration and biopsy which are usually done together. These tests are vital for an accurate diagnosis.

The bone marrow samples for these tests are usually taken from the hip bones but may be taken from the front pelvic or other bones if necessary. For a bone marrow aspiration, a small needle and syringe is used to draw a small amount of liquid marrow from the bone. Because this is usually quite painful, a local anesthetic is usually applied or the child may be sedated during the procedure. After the aspiration is completed, the doctor will usually immediately perform the biopsy. For the biopsy, the doctor will use a larger needle to collect a bone and marrow sample. These tests are used for diagnosis and is repeated periodically to see if the patient is responding well to the treatment.

Another test done is the lumbar puncture, usually called a "spinal tap." The purpose of this test is to look for leukemia cells in the cerebrospinal fluid (CSF). For the spinal tap, a needle is placed between the bones of the spine in the lower back to withdraw some of the fluid. This is an extremely delicate test that is performed by an expert to prevent complications during or after the procedure. Even if there are no leukemia cells present, accidental bleeding could cause some leukemia cells to enter the CSF and start to grow there.

Lastly, a lymph node biopsy is occasionally performed (rarely on children) for diagnosis. In this procedure, the doctor will remove the entire lymph node. They will often prefer to remove a node near the surface of the skin but extractions in the chest or abdomen have been necessary at times.

The role of a laboratory technician in the diagnosis process is profound. Standard lab tests to diagnose and classify leukemia includes--but are not limited to--microscopic examinations, immunophenotyping, and a variety of chromosome tests (karyotyping).

Microscopic examinations are a fundamental lab test done for diagnosis. Blood counts indicate the number of blood cell in a sample and can indicate if there are too many or too few of a type of blood cell in a specimen. When doing a blood smear, the technician or doctor is looking to find abnormalities in or of the cell. A major factor in the process is examining the maturity of the cell. A warning flag would be finding too many immature cells in the blood culture.

Immunophenotyping is identifying the type of leukemia based on the proteins in and around the cell. Though immunophenotyping can be done on any type of blood or other body fluids, it is usually done on bone marrow. It is important to identify the type of leukemia. Flow Cytometry is another method of identifying leukemia based on the cell's antigenic characteristics. This is important because cells with more chromosomes are more responsive to chemotherapy.

There are a variety of chromosome tests done in the lab. The test types include cytogenetics, polymerase chain reaction (PCR), and fluorescent in situ hybridization (FISH). In cytogenetics, leukemia cells are grown in a petri dish and examined under a microscope for errors in the chromosomes. PCR is a very delicate test used to find the smallest changes to chromosomes that are too small to be detected during cytogenetics. FISH is a test that uses specific pieces of DNA that only match the ends of specific chromosomes. FISH is useful in many ways including finding chromosome changes like inclusion, exclusion and translocation.

There are other technical tests, such as imaging tests, used in the diagnosis of leukemia. These tests include bone scans, CT, MRI, X-Rays, digital sonography and more.

Due to the specific nature of the treatments and the unique needs of the patient, a pediatric oncologist typically leads the childhood leukemia treatment team. The treatments for leukemia in children include chemotherapy, surgery, targeted drugs, radiation therapy, and stem cell transplant. Of these treatment methods and options, chemotherapy is the main treatment. Stem cell transplants may be used in high-risk, aggressive treatment situations along with higher doses of chemotherapy. Other treatment options such as surgery, radiation therapy, and target drugs are generally used in special circumstances.

The treatment itself for leukemia can be absolutely devastating for the child. Though children often have a better rate of recovery than adults, children are often more physically and emotionally affected by the treatment which could, and often does, take years to complete. Though the treatment may be long and arduous, the survival rate for childhood leukemia has improved greatly over the years. The 5-year survival rates for ALL, the most common form of leukemia in children, is about 85%.

Conclusion

Childhood leukemia is a cruel affliction. It is the most common form of cancer among children and can happen in anyone's family. The symptoms are severe and cruel and the treatment is usually long, painful, and costly. Through carefully conducted diagnosis and case-specific treatment plans, doctors and their teams can combat this illness successfully, more often than not. Thankfully, because of great progress in medicine and immunology, children with the most common form of leukemia have a higher chance than ever before of surviving both the illness and the treatment.

References

Harpani PT, BJ Parmar, Makwana AM. Clinicopathological Profile of Acute Leukemia in Children. J Nepal Paediatr Soc 2012;32(2):95-98. May-August, 2012/Vol 32/Issue 2 doi: http:// dx.doi.org/10.3126/jnps.v32i2.6038

Leukemia in Children. (n.d.). Retrieved December 05, 2016, from http://www.cancer.org/cancer/leukemiainchildren/

Harpani PT, BJ Parmar, Makwana AM. Clinicopathological Profile of Acute Leukemia in Children. J Nepal Paediatr Soc 2012;32(2):95-98. May-August, 2012/Vol 32/Issue 2 doi: http:// dx.doi.org/10.3126/jnps.v32i2.6038

Carlo Ledesma, MS, MT(AMT), SH(ASCP)QLS, MT(ASCP), Program Director, Medical Laboratory Technology and Phlebotomy, Rose State College, Midwest City, OK; Chiemi Standridge, BS, Medical Technologist, Diagnostic Laboratory of Oklahoma, Oklahoma City, OK
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Title Annotation:Article 453 1 Clock Hour
Author:Ledesma, Carlo; Standridge, Chiemi K.
Publication:Journal of Continuing Education Topics & Issues
Article Type:Disease/Disorder overview
Date:Aug 1, 2018
Words:1613
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