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Acute lymphoblastic leukaemia — MRCPCH FOP MCQ

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HardHaematology and oncologyAcute lymphoblastic leukaemiaMRCPCH FOP

A 4-year-old boy has fever, leg pain and bruising. Examination shows pallor, petechiae and hepatosplenomegaly; full blood count shows Hb 76 g/L, platelets 38 x 10^9/L and neutrophils 0.6 x 10^9/L. What is the most appropriate investigation?

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Correct answer: B — Urgent blood film and paediatric oncology referral

Bone pain, fever, bruising, hepatosplenomegaly and pancytopenia are concerning for acute leukaemia, requiring urgent blood film and specialist referral. Iron deficiency would not explain neutropenia and thrombocytopenia with organomegaly. A viral illness can cause transient cytopenias but the combined clinical picture is high risk. The pearl is that limb pain can be a presenting symptom of childhood leukaemia.

Reference: NICE NG12 Suspected cancer recognition and referral; CCLG guidance