Booklet for Hemato-Oncologists
Case 1 (A, B) - Aphasia and headache in a 9-year old boy with T-ALL and hyperleukocytosis
Child, 9 years old, male, affected by T-ALL, with hyperleukocytosis (WBC = 700,000/mm³), severe hepatosplenomegaly (> 7 cm) and mediastinal enlargement. He was receiving only steroids. At day +2 he presented aphasia and headache.
A - The presence of headache in this child induces you as sequential scheduling to look for:
1. Lumbar puncture, cCT scan or cMRI, platelets (PLT) count
2. PLT count, cCT scan or cMRI and lumbar puncture only following a possible PLT transfusion
3. Coagulation profile, PLT count,c MRI, EEG, lumbar puncture
4. EEG, cCT scan, lumbar puncture
5. cCT scan or MRI, EEG, lumbar puncture
B - When do you consider it helpful to use leukapheresis?
1. WBC > 200,000/mm³
2. WBC > 300,000/mm³
3. WBC > 500,000/mm³
4. Never in a child aged less than 2 years
5. Depending from his/her clinical conditions (e.g. presence of neurological disturbances)
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