Paediatric Leukaemia in Sub-Saharan Africa.
Fatigue, recurrent fever, and easy bruising for the past 3 weeks
K, a previously healthy 6-year-old, presented to the paediatric clinic with complaints of persistent fatigue, recurrent low-grade fever, and unexplained bruising on his arms and legs. His mother noticed that he has been more irritable and pale over the past few weeks. She also reports occasional nosebleeds and that K has been frequently getting infections, including a persistent sore throat that hasn’t resolved with home remedies.
There is no family history of chronic illnesses or cancers. His vaccination history is incomplete, with gaps due to difficulty accessing healthcare. Kofi attends school but has recently been missing classes due to illness.
Vital Signs:
Temperature: 38.5°C (febrile)
Heart rate: 110 beats per minute
Respiratory rate: 26 breaths per minute
Blood pressure: 100/65 mmHg
General: Pale, fatigued appearance with mild distress. Multiple bruises noted on extremities. No jaundice or cyanosis.
Lymph nodes: Enlarged cervical and axillary lymph nodes.
Abdominal exam: Hepatosplenomegaly palpable 4 cm below the costal margins.
Musculoskeletal: No joint swelling or tenderness, but generalized bone pain on palpation
Full blood count: Haemoglobin 7.0 g/dL (low), White blood cell count 35,000/mm³ (elevated), Platelets 40,000/mm³ (low).
Peripheral blood smear: Blasts present, highly suggestive of leukaemia.
Bone marrow aspiration: Confirms diagnosis of acute lymphoblastic leukaemia (ALL) with over 20% blast cells.
Chest X-ray: Mild mediastinal widening, suggestive of lymphadenopathy.
Cytogenetics: Awaiting results to identify any specific chromosomal abnormalities.
K has been diagnosed with acute lymphoblastic leukaemia (ALL), the most common form of paediatric leukaemia. His symptoms of fatigue, recurrent infections, easy bruising, and hepatosplenomegaly align with the clinical presentation of ALL. His condition was likely exacerbated by delayed healthcare access, common in parts of Sub-Saharan Africa.
- Initial stabilization:
Blood transfusion for anaemia.
Platelet transfusion due to thrombocytopenia and risk of bleeding.
Broad-spectrum antibiotics for the ongoing infection.
Chemotherapy: Initiate the standard treatment protocol for ALL, including induction therapy with drugs such as vincristine, corticosteroids, and L-asparaginase.
- Supportive care:
IV fluids to maintain hydration.
Pain management with paracetamol for bone pain.
Nutritional support due to his frail condition.
- Counselling and follow-up:
Regular monitoring of blood counts and bone marrow response.
Psychological support for the family to help cope with the long treatment course.
Referral to a regional cancer center for ongoing chemotherapy and possible radiation therapy if necessary.
K and his family were counselled on the nature of leukaemia, the treatment plan, and the prognosis. Given the early stage and initiation of treatment, his prognosis was cautiously optimistic, although the challenges of maintaining regular chemotherapy cycles in a resource-limited setting were acknowledged. Follow-up care, including management of complications such as infections and nutritional deficiencies, will be essential in improving his chances of remission.
a). Iron deficiency anaemia
b). Malaria
c). Acute lymphoblastic leukaemia (ALL)
d). Sickle cell anaemia
a). Fatigue
b). Bruising
c). Bone pain
d). Seizures
a). High haemoglobin levels
b). Presence of blast cells
c). Decreased white blood cell count
d). Fragmented red blood cells
a). Surgery to remove lymph nodes
b). Antibiotics and blood transfusion
c). Radiation therapy only
d). Non-steroidal anti-inflammatory drugs (NSAIDs)
Answers
- c) Acute lymphoblastic leukaemia (ALL)
- d) Seizures
- b) Presence of blast cells
- b) Antibiotics and blood transfusion