A pediatric patient with one or more clinical findings should be evaluated for the possibility of leukemia.


Indications for a complete blood count (CBC) with examination of the peripheral blood smear:

(1) pallor

(2) fatigue

(3) unexplained irritability

(4) unexplained fever

(5) recurrent or persistent upper respiratory tract infections

(6) generalized lymphadenopathy

(7) persistent or unexplained bone pain

(8) unexplained bruising

(9) unexplained petechiae

(10) unexplained hepatosplenomegaly


Reasons to refer a patient to a hematologist:

(1) either of the latter 2 indications (petechiae, hepatosplenomegaly)

(2) presence of blasts in the peripheral blood smear

(3) other reasons to suspect leukemia (unexplained pancytopenia, etc)


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