In this article, we will talk about a serious disease, the signs of which everyone should know. It is especially important to be aware of how it manifests itself among the young inhabitants of the planet. Therefore, we highlight the symptoms of leukemia in children, the causes of the disease, the classification of its types, especially the diagnosis and treatment. And let's start by defining the disease.
Leukemia - what is it?
Leukemia, leukemia is a malignant pathology, blood cancer, which characterizes the tumor proliferation of immature cell mass - the precursors of white blood cells. As for children, the clinical manifestation of the disease here includes hemorrhagic syndrome, swollen lymph nodes, joint and bone pain, central nervous system damage, hepatosplenomegaly.
The essence of the disease is that in a child in the bone marrow the process of hematopoiesis is disrupted. White blood cells ("white cells"), which play a protective role in our body, are not completely formed. From here, unripe (blast) cells enter the blood, disturbing the harmonious balance in it. Blast particles, unlike leukocytes, do not perform a protective function.
Thus, leukemia is a manifestation of systemic hemoblastosis, which is facilitated by a violation of bone marrow hematopoiesis, the replacement of normal blood cells with leukocyte immature blast cells. If we look at the statistics of pediatric oncohematology, then the symptoms of leukemia in children (photos on this topic are presented in the article) are found in 4-5 cases out of 100,000. The most common childhood cancer (30%) is acute leukemia. Most often, it affects children 2-5 years old. Leukemia can be called the most common cause of infant mortality.
Diagnosis of symptoms of leukemia in children mainly consists of sternal puncture, examination of samples of punctate brain. Treatment of small patients takes place in hematological special centers through immunotherapy, chemotherapy, bone marrow transplantation, and replacement therapy.
One of the most urgent problems of pediatrics today is a decrease in the growth trend of the incidence of leukemia, the fight against high mortality.
Causes of the disease
The aspects of the development of symptoms of leukemia in children are still not completely clear. Some of the researchers believe that this is a viral disease, someone - a genetic one. It is also possible that oncogenes (mutated) are inherited. They are formed under the influence of retroviruses.
Oncogenes begin their pernicious effect in the perinatal period. But until a certain stage in the development of the child’s body, they are destroyed by the immune system. Only with its weakening does leukemia develop.
Modern medicine has been able to prove the influence of the following:
- Oncogenic viral strains.
- Radiation
- Hereditary predisposition.
- Immune, hormonal and endogenous disorders.
- Chemical factors.
Doctors note that leukemia is more likely to develop in identical twins than in twin. Secondary leukemia is most often observed in children who have undergone radiation or chemotherapy as a result of the treatment of another cancer. It is also noted that in children suffering from Down's disease, leukemia develops 15 times more often than in others. An increased risk is also observed with the following pathologies:
- Fanconi Anemia
- Lee-Fraumeni syndrome.
- Primary immunodeficiencies.
- Bloom's syndrome.
- Wiskott-Aldrich Syndrome.
- Klinefelter's syndrome.
- Polycythemia.
The mechanism of the development of the disease
Today, the mechanisms for the development of symptoms of blood leukemia in children are considered from the angle of the clone concept and mutational theory. Imagine this in general terms.
A hematopoietic cell DNA mutation occurs, which is accompanied by a failure of differentiation at the blast stage of an immature cell, followed by proliferation. Hence leukemia cells are clones of an altered cell mutation that are not capable of differentiation and maturation, which suppresses normal blood-forming sprouts.
Blast cells spread throughout the body, entering the bloodstream, which contributes to leukemic infiltration of tissues and organs. Metastatic penetration of blast cells occurs through the blood-brain barrier, which leads to the infiltration of the substance and membranes of the brain and the subsequent development of neuroleukemia.
Disease classification by duration
Continuing to talk about how leukemia develops in children, about symptoms, we distinguish two forms of the disease:
- Acute. Duration - less than 2 years. More than 97% of cases. Congenital leukemia is considered a separate form.
- Chronic form. Duration - more than 2 years.
Classification of the disease according to morphological characteristics
According to the morphological characteristics of tumor cells, the symptoms of acute leukemia in children, in turn, can be divided into 2 types:
- Lymphoblastic. It develops with uncontrolled proliferation of an immature type of white blood cells (or lymphoblasts). Inside it is divided into three types - with large polymorphic lymphoblasts, small lymphoblasts, large with vacuolization of the cytoplasm, polymorphic lymphoblasts.
- Non-lymphoblastic. Based on the predominance of certain blast cells, several types of symptoms of blood leukemia in children can be distinguished. It is undifferentiated, monoblastic, eosinophilic, myelomonoblastic, megakaryocytic, promyelocytic, myeloblastic, highly differentiated, myeloblastic, slightly differentiated.
By antigenic markers, one can distinguish B-cell (1-3%), T-cell (15-25%), 0-cell (70-80%) types of acute leukemia.
Stages of the disease
In addition to understanding the causes and symptoms of leukemia in children, it is important to navigate the stages of the disease:
- The acute phase. This is the stage from symptomatic manifestation to improvement of clinical and hematological characteristics due to the treatment.
- Remission - complete or incomplete. At the first view, no more than 5% of blast cells in the total mass are found in the myelogram. If incomplete, normalization of clinical indicators and myelograms can be noted. In bone marrow puncture, no more than 20% of blast cells of the total mass are observed.
- Relapse of the disease. With general hematological well-being, extramedullary foci of leukemic infiltration in the lungs, nervous system, testicles and other organs are noticed.
General and first symptoms of leukemia in children
The disease can develop both acutely and gradually. Its aggravation is characterized by the following syndromes:
- Hemorrhagic.
- Cardiovascular.
- Immunodeficiency
- Intoxication.
Most often, the disease begins to develop rapidly and suddenly. This is followed by the following:
- Strong fever.
- Nosebleeds.
- Infectious lesions of the oropharynx.
- General weakness.
The slow development of the disease is characterized by the following manifestations:
- Pain in joints and bones.
- Marked decrease in appetite.
- Headaches.
- Sleep disturbance.
- Fatigue.
- Cramps.
- Vomiting
- A significant increase in temperature.
- Weight loss.
- Sweating.
Non-specific manifestations include:
- Sleep disturbance.
- General fatigue.
- Unmotivated fever.
- Ossalgia.
- Decreased appetite.
- Arthralgia.
- Hemorrhagic, intoxication syndrome.
We continue to analyze the symptoms of leukemia in children:
- Pallor - both the mucous membranes and the skin.
- In some cases, the skin acquires an earthy, icteric hue.
- Stomatitis, tonsillitis, gingivitis are the result of leukemic infiltration.
- Lymphadenopathy is the result of leukemic hyperplasia of the lymph nodes.
- Sialadenopathy is a lesion of the salivary glands.
- Hepatosplenomegaly - damage to the spleen and liver.
- Lethargy.
- Dyspnea.
- Bruising on mucous membranes and skin.
- Cardiopalmus.
- Enlarged submandibular and parotid salivary glands, as well as lymph nodes.
Symptoms of acute leukemia in children are as follows:
- Hemorrhagic syndrome. It is distinguished by hemorrhage in the mucous membranes and skin.
- Hematuria
- Uterine, gastrointestinal, nasal, pulmonary hemorrhages.
- Different in degree of hemorrhage in the joint cavity.
- Anemic syndrome that causes bleeding and inhibition of erythropoiesis.
Symptoms of acute lymphoblastic leukemia in children caused by cardiovascular disorders:
- Arrhythmia.
- Tachycardia.
- Expansion of the heart.
- Diffuse changes in the myocardium.
- Reduced ejection fraction.
The course of leukemia in children is complicated by intoxication syndrome. It calls:
- Weakness.
- Sweating.
- Fever.
- Nausea, vomiting.
- Anorexia.
- Hypotrophy.
Speaking about the symptoms of leukemia in infants, it is impossible not to note the manifestations of immunodeficiency syndrome:
- Infectious, inflammatory processes, often taking place in a severe form.
- Sepsis, a complex form of pneumonia. Often leads to the death of small patients.
Hemorrhagic syndrome manifests itself as follows:
- Pulmonary hemorrhage.
- Nose bleed.
- Hemorrhages in the skin, articular cavities, in the mucous membranes.
- Bleeding in the organs of the gastrointestinal tract.
- Reduced levels of red blood cells and hemoglobin in the blood.
- The appearance of blood in the urine.
Cardiovascular syndrome with leukemia manifests itself as follows:
- Heart rhythm disturbance.
- Increased heart rate.
- Diffuse changes in the heart muscle, noticeable on the ECG.
- Altered heart borders.
- On the echo ECG, a reduced ejection fraction is detected.
Consider the late symptoms of the disease:
- The appearance of bruises on the skin from a simple press.
- Profuse and frequent nosebleeds.
- Small rash of scarlet color, located in small areas.
- Unreasonable weight loss.
- Pallor.
- Prostration.
- Jaundice - indicates a gradual failure of the liver.
Leukemia complications
After analyzing the symptoms of leukemia in children, we turn to the complications of this disease. The most dangerous of them will be leukemic infiltration of the meninges, brain, nerve trunks.
Neuroleukemia is accompanied by the following symptoms:
- Headache.
- Dizziness.
- Diplopia.
- Nausea.
- Stiff neck.
If there is an infiltration of the substance of the spinal cord, then a violation of sensitivity, pelvic disorders, paraparesis of the lower extremities may develop.
Diagnostics
The first doctor who identifies the symptoms of leukemia in children by external signs, a blood test, is a pediatrician. Further observation, examination is the prerogative of the pediatric oncologist. The basis for the diagnosis of pathology is laboratory methods. In particular, the study of blood, peripheral brain.
Acute leukemia in a child is detected by characteristic changes in the blood test:
- thrombocytopenia;
- anemia;
- leukopenia, leukocytosis of varying severity;
- blastemia
- high ESR;
- reticulocytopenia;
- lack of eosinophils and basophils.
A typical symptom of the disease is the phenomenon of "leukemic failure." This is the name of the lack of diversity of intermediate forms (stab, young, segmented white blood cells) between mature and blast cells.
Mandatory points for the diagnosis of childhood leukemia is the study of myelogram, sternal function. The doctor makes the final decision in the diagnosis when the number of blast cells exceeds 30%. If it is impossible to come to an unambiguous conclusion, an ilium puncture is performed - trepanobiopsy. To determine the variant of acute leukemia, specialists need to conduct cytogenetic, cytochemical and immunological studies.
To confirm the diagnosis, the following is necessary:
- Consultation of an ophthalmologist and neurologist.
- X-ray of the skull.
- Lumbar puncture.
- Ophthalmoscopy
- The study of cerebrospinal fluid.
The auxiliary diagnostics are usually as follows: ultrasound of the salivary glands, spleen, lymph nodes, scrotum in boys, chest x-ray, CT.
Differential diagnosis of leukemia in children with a leukemia-like reaction, which is observed with sepsis, whooping cough, severe tuberculosis, cytomegalovirus infection, and infectious mononucleosis, is mandatory.
Disease treatment
If in children the symptoms of lymphoblastic leukemia and its other types are confirmed, then patients are hospitalized in specialized oncohematological institutions. To prevent infection, the child is placed in a box, the conditions in which are close to sterile. Doctors must monitor the patient’s nutrition - it must be balanced and complete.
The basis for the treatment of the disease is polychemotherapy. It is aimed at the comprehensive eradication of leukemic clones. The types of therapy used in myeloblastic and lymphoblastic leukemia have differences in the combination of chemo drugs, their doses and the types of administration. The phased treatment of the acute form of the disease involves the achievement of clinical and hematological remission, its consolidation (consolidation), prevention, supportive treatment, and prevention of remissions.
Chemotherapy is often supported by immunotherapy. It consists in a passive and active type:
- BCG vaccines.
- Interferons.
- Leukemia cells.
- Immune white blood cells.
Symptomatic treatment is as follows:
- Transfusion of platelet and erythrocyte composition.
- Hemostatic therapy.
- Taking antibiotics against infectious complications.
- Detoxification therapy - plasma sorption, intravenous infusion, hemosorption, plasmapheresis.
Promising methods of treatment are as follows: transplantation of cord blood , stem cells, bone marrow.
Predictions of the development of the disease
We have already examined how leukemia manifests itself in children, symptoms of pathology. The development of the disease is influenced by many factors - the age of the patient, the stage at which the disease was detected, and the cytoimmunological variant.
The following patients have the worst prognosis of the disease:
- With acute leukemia under the age of 2 years and older than 10 years.
- With established hepatosplenomegaly and lymphadenopathy.
- Having neuroleukemia at the date of diagnosis.
- With B- and T-variants of leukemia.
- With the diagnosis of blast hyperleukocytosis.
A more favorable prognosis is characteristic for these cases:
- Lymphoblastic acute leukemia L1 type.
- Rapid achievement of the remission stage.
- Early start of therapy.
- The age of the patient is from 2 to 10 years.
- If the sick person is a girl, then she has more chances for a cure than a boy.
If there is no special treatment, then the disease in 100% case leads to death. Modern chemotherapy allows reaching a 5-year relapse-free course of leukemia in 50-80% of small patients. One can talk about recovery today after 6-7 years of absence of relapse. In order not to provoke it, children are not recommended to change climatic conditions, conduct physiotherapeutic treatment.
Leukemia, blood cancer - a serious disease, the symptoms of which in children must be thoroughly known. There are still no clear causes of blood cancer. However, its diagnosis in the early stages, complex treatment is currently able to save the life of a small patient.