Booklet for Hemato-Oncologists
Case 8 (A, B) - Mucous bleeding, PLT count < 30,000 but normal coagulation profile in a 6-month old child with T-ALL and hyperleukocytosis successfully treated with leukopheresis
Child, 6 months old, male, affected by T-ALL with hyper-leukocytosis (WBC = 400,000/µl). He performed successfully leukapheresis (WBC decreased to 50,000/µl) and received steroids as early treatment. PLT count at day + 7 was < 30,000/µl with mucous bleeding but normal coagulation profile. He didn't present fever.
A - What is your approach looking at platelets?
1. Give random-donor PLT every other day
2. Wait and see
3. Give PLTs from apheresis and continue to do so according to PLT values
4. Monitor PLT count every day
5. Discontinue chemotherapy
B - You need to perform therapeutic lumbar puncture. What do you suggest?
1. Do it without any extra prevention
2. Don´t do it
3. Do it following PLT transfusion (to increase PLT count to > 50,000/µl)
4. Do it following fresh plasma transfusion
5. Do it keeping the child in leaning position
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