Clinical and Laboratory Manifestation of Children with Acute Lymphoblastic Leukemia as an Assessment of Severity: A Study in Dr. Hasan Sadikin General Hospital

Abstract

Background: Acute lymphoblastic leukemia (ALL) is a disease caused by a mutation of lymphoid progenitor cells in bone marrow, that induces uncontrolled lymphoid cell proliferation. ALL is the most common type of leukemia in children. Various clinical and laboratory manifestation makes the diagnostic process more complicated. This study aimed to observe the clinical and laboratory manifestation of children with ALL in Dr. Hasan Sadikin General Hospital for diagnostic and assessment. Methods: The design of this study was a descriptive cross-sectional with a total sampling method. Data of all children under 18 years old with ALL diagnosed in 2015 to 2017 were included. The diagnosis of ALL was confirmed by examination of hematology indices, peripheral blood smear, and bone marrow aspiration classified by FAB. Inaccessible or incomplete medical records were excluded. Results: In total, 192 data of ALL patients were included. Most ALL patients predominantly occurred in boys (59.9%), and the age group of 1-5 years old (40.6%). The clinical manifestations were pallor (89.6%), hepatomegaly (79.7%) and fever (75%). Most patients experienced severe anemia with hemoglobin level <7g/dL (44.8%), leukocytosis >20.000 cells/mm3 (46.9%), severe thrombocytopenia with platelet count <20.000 cells/mm3 (51%), and blast cells count >50% (45.3%). Based on FAB classification, the majority of the patients were classified as ALL type L2 (65.6%). Conclusions: Clinical and laboratory manifestation of ALL patients can be used as a parameter for diagnostic and assessment of severity. Earlier diagnosis would result in better prognosis and more precise treatment for ALL patients.

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“…The research showed that LLA was more common in boys (52.8%). Previous research at Hasan Sadikin Hospital in Bandung in 2016 obtained the same results, namely, the majority of ALL occurred in boys, as did other studies [10][11][12]. A systematic review and meta-analysis conducted in Indonesia showed that ALL was more common in boys, 2.45 per 100,000 children, than in girls, 2.05 per 100,000 children [13].…”

“…Most patients had a platelet level of 20,000−99,000/uL at 52.8%. Previous research at Hasan Sadikin Hospital found that severe anemia with hemoglobin levels <7 g/dL occurred in 44.8% of cases, leukocytosis occurred in 46.9% of cases, and severe thrombocytopenia occurred in 55% of cases [10] Other studies showed that at the time of diagnosis, the median leukocytes were 7120/uL (450−600,000/uL), the median hemoglobin was 7.5 g/dL (2,4−15.3 d/dL), the median platelets were 47,400/uL (4,000−544,000 /uL). Leukocytosis occurred in 36.6% of cases, leukopenia occurred in 36.1% of cases, and anemia was found in 82.9% of cases [18].…”

“…The most frequent clinical manifestations were pallor (94.4%), fever (86.1%), hepatomegaly (72.2%), lymphadenopathy (69.4%), splenomegaly (63.9%), bleeding (44 .4%) and bone pain (30.6%). Research conducted at Hasan Sadikin Hospital showed that the clinical manifestations that often appeared were paleness, hepatomegaly, and fever [10]. A systematic review and meta-analysis study by Clarke at al (2016) showed that the five most common symptoms in >50% of ALL children were hepatomegaly, splenomegaly, pallor, fever, and bruising [16] Meanwhile, a study in Saudi Arabia showed that the most common symptoms in ALL children were fever, fatigue, bone pain, paleness, weight loss, and decreased consciousness [17].…”

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“…Similarly, another study reported that 69.8% of their total sample of children with all were aged 1-10 years. 20 Studies in 184 countries also showed peaks in the 0-4 year range, but the exact etiology of these findings has not been found, and no studies have discussed it. 21,22 However, there is a hypothesis that the mechanism of infection as a secondary stimulator of preleukemic genetic alterations leads to development of ALL; infections are common in early childhood.…”