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Acute lymphoblastic leukaemia — RACP Paediatrics MCQ

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HardHaematology and oncologyAcute lymphoblastic leukaemiaRACP Paediatrics

A 4-year-old has three weeks of fever, bone pain and bruising. Examination shows pallor, hepatosplenomegaly and cervical lymphadenopathy; FBC shows anaemia, thrombocytopenia and circulating blasts. What is the most appropriate investigation?

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Correct answer: A — Urgent bone marrow assessment after haematology referral

Bicytopenia with blasts, bone pain and organomegaly is acute leukaemia until proven otherwise, requiring urgent haematology-led marrow assessment. Iron deficiency does not cause blasts or hepatosplenomegaly. The pearl is that bone pain and limp can be presenting features of childhood leukaemia.

Reference: RCH Clinical Practice Guidelines; Australian paediatric oncology guidance