Acute lymphoblastic leukaemia (ALL) - Basis for logical management

ALL

• ALL occurs mainly in >15s
• 15-25 common
• Older ages are far less common
• Causes aplastic anaemia
• High number of lymphoblasts cause increased viscosity in the blood, increasing risk of stroke

Management

• Don't give transfusion first! Look at the child! Even with a very low Hb, the child may be well!
• In fact, don't quickly give transfusion at all if necessary, since this will exacerbate the INCREASED VISCOSITY CAUSED BY THE LYMPHOBLASTS
• IV fluids are better since it does two main things
• Stimulates white cell lysis (also induced by dexamethasone given with bone marrow transplant)
• This increases uric acid and increases potassium
• Allopurinol (for uric acid)
• Urate oxidase (for uric acid)
• Hopefully IV fluid can flush all these through the kidneys
• Treat hyperviscosity