Diagnosis Symptoms and Clinical Signs

The clinical presentation in children, adolescents, and young adults is mostly similar (Table 7.2). It reflects the degree to which the bone marrow has been infiltrated with leukemic blasts and the extent of extra-medullary involvement, and can be both a reflection of tumor biology and health services factors (host- and provider-related delays in diagnosis). The most com mon symptoms and physical findings result from anemia, thrombocytopenia, and neutropenia, and include pallor and fatigue, anorexia, petechiae, purpura, bleeding, and infection. Occurrence of initial hyperleukocy-tosis (white blood cell count>100,000/^l) did not vary significantly in the different age groups. Initial involvement of the central nervous system (CNS) is seen less often in adolescents (~10%) and in children aged 213 years (~8%) than in infants (~17%) with AML (data not available for young adults, who rarely get diagnostic lumbar puncture). Infiltration of the skin, especially in monocytic leukemias, is also most frequent (~20%) in young children (<2 years) and rarely seen in older children and adolescents. Likewise, leukemic infiltrations of the periosteum and bone occur more often in young children than in adolescents.

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