Hematological and Clinical Presentation of Acute Leukemiasat Khyber Pakhtoonkhwa

Abstract

Background: The clinical presentation of acute leukemias is quite variable. The present study was designed to assess the hematological and clinical presentation of acute leukemias in our setup.

Methodology: This comparative study was conducted in medical and paedriatic wards of Lady Reading Hospital Peshawar, IRNUM Hospital Peshawar and DHQ Hospital Bannu from 2000 to 2006. A total of 50 patients of acute leukemias were included in the study. These patients belonged to all age groups, both sexes and mixed socio-economic status. The diagnosis was made on clinical history, physical examination and peripheral blood and bone marrow examination.

Results: Out of 50 cases, 28 (56%) were of acute lymphoblastic (ALL), 20 cases (40%) acute myeloid leukemias (AML), while 2 (4%) were of undefferianted type. All patients were anemic at the time of diagnosis, their hemoglobin mm3 was 2.8 -12 g /dl. The TLC was quite variable ranged from <4000/cmm to >6,30,000/ mm3. Similarly the platelet count was <10,000 to >100000/mm3. The majority (90%) presented with fever and malaise. Abnormal bleeding was present in 20 cases (40%) at the time of presentation. Chest infection was the most common type of infection (38%). Bone and joint pain was present in 12 cases (24%). Vomiting diarrhea were present in 10 cases (20%). Disturbance of vision and hearing was also present in 5 cases (10%). Signs symptoms of mediastinal obstruction were present in only 3 cases (10.7%) of ALL. Skin rash was present in 2 cases (4%). Proptosis of eye was significant clinical feature in one child with ALL at presentation. One Child with ALL had multiple soft swellings at presentation. Two cases (4%) presented with jaundice while 2 (4%) had signs and symptoms of fracture L1 vertebra at presentation and one case presented with weakness of right side of the body.

Conclusion: The clinical presentation of acute leukemias is so variable and atypical that in most of the cases the diagnosis is delayed for a quite long time, due to which the prognosis becomes poor in our setup.