What could cause low Hb and acute lymphoblastic leukemia in a 9-year old?

Question

Hi doctor,

My son is 9 years old. He had the flu and vomiting for a few days. He got better and was back to normal after four days. He started complaining of tiredness even after doing normal activities, like going to the second floor and writing his homework.

He was sweating abnormally at night without a sign of fever, and his body temperature was just normal. After visiting the doctor, the blood test showed his Hb is below normal (6.0), and he decided to be hospitalized and get blood. Please refer to the attached laboratory test report for the rest of the lab tests taken after that.

Can you please advise what issue he might have?
What are the other options?
Is there a treatment for his case?

Kindly guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Based on the provided history and reports (attachment removed to protect patient identity), it seems to be a hemolytic anemia case. The cause of hemolytic anemia should be searched for. Dengue should also be ruled out by the IgM ELISA (enzyme-linked immunosorbent assay) test and the NS1 (nonstructural protein 1) antigen test. The spleen is also enlarged. So, most probably it is hemolytic anemia.

Elevated bilirubin also favors diagnosis. He needs to visit the hematologist for a detailed physical examination, and accordingly, management can be planned. In hemolytic anemia, RBCs (red blood cells) are destroyed.

Autoimmune hemolytic anemia, G6PD (glucose-6-phosphate dehydrogenase) deficiency, PNH (paroxysmal nocturnal hemoglobinuria) hemoglobinopathy, and spherocytosis are some of the causes of hemolytic anemia. To increase hemoglobin and platelets, a blood transfusion is needed.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

There is a presence of low hemoglobin and low platelets. If the hematologist does not find any cause for hemolytic anemia, then further workup should be done to exclude leukemia and myeloproliferative disorder.

A bone marrow biopsy for your child can be planned for further workup. Bone marrow biopsy is a gold standard test to exclude all blood cancers. Therefore, discuss with the hematologist about planning for a bone marrow biopsy.

In the attached report (attachment removed to protect patient identity), no abnormal malignant cells are present. So, leukemia cannot be ruled out from the CBC (complete blood count) report only. To exclude leukemia, I suggest a bone marrow biopsy or flow cytometry as a higher investigation. There is the possibility of leukemia as well when bicytopenia is present.

I hope this helps you.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

The attached report shows B-cell acute lymphoblastic leukemia (attachment removed to protect patient identity). So, your doctor is right. He is having ALL types of blood cancer. Therefore, I suggest he should be put on treatment for ALL. Prognosis is very good in children, and remission occurs in most cases.

I am sorry, he has blood cancer. But do not worry. Prognosis and ten-year survival rate are good for this type of blood cancer. I suggest you start treatment after a physical examination by a hematologist.

I hope you are satisfied with my answer.

For further queries, you can consult me.

Thank you.

Answer 4

Hello,

Welcome back to icliniq.com.

Following is my opinion on your question. I am sorry to hear that the kid has leukemia, which means blood cancer. In the attached reports, there are three CBC (complete blood count) reports, but they are not conclusive in ruling out leukemia. Therefore, bone marrow aspiration and flow cytometry are suggested. Now, note the following important positive findings:

The liver and spleen are enlarged.
In the bone marrow, 74 percent blast cells are mentioned.
Flow cytometry shows an ALL (acute lymphoblastic leukemia) picture.
With more than 20 percent blast cells in the bone marrow or smear and enlarged liver and spleen, this is highly suggestive of blood cancer. Considering all the reports, it is indicative of ALL type of blood cancer.

You can consult a hematologist or hematology oncologist nearby to begin treatment. But do not worry, the prognosis and ten-year survival rate are good for this type of blood cancer.

Hope I have answered your doubt and question. Let me know if you have more questions.

Thank you.