CareTalk Blog: Nemours Center for Cancer and Blood Disorders

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Leukemia

The term leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). Leukemias, as a group, make up about a quarter of all pediatric cancers. Luckily, with treatment, most children with leukemia will be free of the disease without it coming back.

Leukemias start in the bone marrow — the soft tissue found inside bones that produces blood cells. When a child is diagnosed with leukemia, it’s because the white blood cells in the body are producing abnormally. These cells (also known as blasts) start to crowd out the healthy cells in the bone marrow. Eventually, the healthy cells have no place to go, so they stop producing. When a child's body no longer produces enough healthy white blood cells it can cause anemia, swollen lymph nodes, and other symptoms of leukemia in children.

Leukemia is classified as being either acute (meaning it’s rapidly developing) or chronic (meaning it’s slowly developing). About 98% of pediatric leukemias are acute.

 
Types of Pediatric Leukemia
Types of leukemia in children include:
  • Acute lymphoblastic leukemia (ALL): This happens when too many lymphoblasts (a certain type of white blood cell) are produced.
    This is the most common type of leukemia, affecting nearly 60% of kids with leukemia.
  • Acute myelogenous leukemia (AML): This occurs when too many immature white blood cells (called myeloid blasts) are made.
    These leukemia cells are abnormal and can’t mature into normal white blood cells.
  • Chronic myelogenous leukemia (CML): This rare form of pediatric leukemia happens because there are too many mature white blood cells.

 
Signs and Symptoms of Leukemia in Children

Although the symptoms of leukemia in each individual child can vary, common symptoms of leukemia in children include:

  • anemia  (when the level of healthy red blood cells in the body becomes
    too low)
  • bleeding and/or bruising
  • frequent or reoccurring infections
  • bone and joint pain
  • abdominal pain
  • swollen lymph nodes (also called “swollen glands”)
  • difficulty breathing
  • excessive fatigue (more tired than usual)
  • poor appetite

IMPORTANT NOTE: Instances of the symptoms of leukemia in children listed above, either together or on their own, do not automatically mean that a child has leukemia or any other kind of cancer. Any or all of these symptoms could be a sign of something else.

 
Diagnosing Leukemia in Children

One of our Nemours pediatric hematologists-oncologists (doctors who treat blood disorders and cancers) will conduct a physical examination on your child to check for symptoms of leukemia in children such as signs of infection, anemia, abnormal bleeding, and swollen lymph nodes.

The doctor will also feel your child's abdomen to see if the liver or spleen is enlarged. We’ll also take a complete medical history by asking about your child’s symptoms, past health, your family's health history, any medications your child is taking, allergies, etc.

After this exam, the doctor will order a CBC (complete blood count) to measure the numbers of white cells, red cells, and platelets in your child's blood. Your child’s blood chemistries will also be checked.

Then, depending on what we find in the exam and blood tests, your child also may need a:

  • bone marrow biopsy and aspiration (when marrow samples are taken for testing, usually from the back of the hip)
  • lymph node biopsy (when lymph nodes are removed and examined under a microscope to look for abnormal cells)
  • lumbar puncture (also called a spinal tap, when a sample of spinal fluid is taken from the lower back and examined for evidence of abnormal cells. This test will show if the leukemia has spread to the brain and spinal cord.)

We know that tests can be scary – for you and your child. Whatever kind of tests your child might need, know that your Nemours pediatric leukemia care team will do everything we can to make the experience as comfortable as possible – physically and emotionally. We’ll give sedation or anesthesia as needed and offer support and guidance at every step.

Learn more about what to expect with certain medical tests »

 
Treating Leukemia in Children

Depending on your child’s age, overall health, extent of the disease, and other factors, treatment may include one or a combination of the following:

  • chemotherapy
  • radiation therapy   
  • blood or bone marrow transplant (also sometimes called a BMT, BBMT, stem cell transplant, or cord blood transplant)
  • medications/antibiotics
  • blood transfusions

At Nemours, we know that getting a cancer diagnosis can be very frightening and overwhelming for your whole family. That’s why Nemours’ board-certified pediatric hematologists-oncologists, specialty nurses, cancer researchers, and other cancer experts are focused on helping not only your child, but your family, as well.

From diagnosis to treatment (and beyond) we’ll be here to help guide your family through your pediatric leukemia journey – and to strive and hope, with you, for a better tomorrow.

Lumbar Puncture (Spinal Tap)

What It Is

A lumbar puncture (LP), often called a spinal tap, is a common medical test that involves taking a small sample of cerebrospinal fluid (CSF) for examination. CSF is a clear, colorless liquid that delivers nutrients and "cushions" the brain and spinal cord, or central nervous system.

In a lumbar puncture, a needle is carefully inserted into the lower spine to collect the CSF sample.

Why It's Done

Medical personnel perform lumbar punctures and test the CSF to detect or rule out suspected diseases or conditions through analysis of the white blood cell count, glucose levels, protein, and bacteria.

Special testing can look for certain bacteria and viruses, or find the presence of abnormal cells that can help identify specific diseases in the central nervous system.

Most LPs are done to test for meningitis, but they also can detect bleeding in the brain and certain conditions affecting the nervous system (such as Guillain-Barré syndrome and multiple sclerosis). LPs also can deliver chemotherapeutic medications.

Preparation

After the procedure is explained to you, you'll be asked to sign an informed consent form — this document states that you give permission for the procedure to be performed and that you understand the procedure, why it is being done, and any potential risks.

The doctor performing the lumbar puncture will know your child's medical history, but might ask additional questions such as whether your child is allergic to any medicines.

You might be able to stay in the room with your child during the procedure, or you can step outside to a waiting area.

The Procedure

A lumbar puncture takes about 30 minutes. The doctor carefully inserts a thin needle between the bones of the lower spine (below the spinal cord) to withdraw the fluid sample.

The patient will be positioned with the back curved out so the spaces between the vertebrae are as wide as possible. This allows the doctor to easily find the spaces between the lower lumbar bones (where the needle will be inserted).

Older kids might be asked to either sit on an exam table while leaning over with their head on a pillow or lie on their side. Infants and younger children are usually positioned on their sides with their knees under their chin.

Lumbar Puncture

Once the child in the correct position, the back is cleansed with an antiseptic like iodine solution and a sterile area is maintained to minimize infection risk. The doctor performing the procedure also wears sterile gloves while performing the procedure.

A small puncture through the skin on the lower back is made and liquid anesthetic medicine is injected into the tissues beneath the skin to prevent pain. In many cases, before the injected anesthesia medication is given, a numbing cream is applied to the skin to minimize discomfort.

The spinal needle is thin and the length varies according to the size of the patient. It has a hollow core, and inside the hollow core is a "stylet," another type of thin needle that acts kind of like a plug. When the spinal needle is inserted into the lower lumbar area, the stylet is carefully removed, which allows the cerebrospinal fluid to drip out into the collection tubes.

After the CSF sample is collected (this usually takes about 2-5 minutes), the needle is withdrawn and a small bandage is placed on the site. Collected samples are sent to a lab for analysis and testing.

Sometimes doctors also measure the amount of pressure in the CSF using a special device called a manometer. High CSF pressure can happen under certain conditions, like meningitis.

What to Expect

While some notice a brief pinch and some discomfort, most people don't consider a lumbar puncture to be painful. Depending on the doctor's recommendations, your child might have to lie on his or her back for a few hours after the procedure. Your child might feel tired and have a mild backache the day after the procedure.

Getting the Results

Some results from a lumbar puncture are available within 45 to 60 minutes. However, to look for specific bacteria growing in the sample, a bacterial culture is sent to the lab and these results are usually available in 48 hours. If it's determined there might be an infection, the doctor will start antibiotic treatment while waiting for the results of the culture.

Risks

A lumbar puncture is considered a safe procedure with minimal risks. Most of the time, there are no complications. In some instances, a patient may get a headache. It's recommended that patients lie down for a few hours after the test and drink plenty of fluids to help prevent headaches, which usually resolve with rest, pain medications, and fluids.

In rare cases, infection or bleeding can occur. Also, trauma to spinal cord is extremely rare when the procedure is done correctly, because the cord ends much higher in the back than the area where the needle is inserted for the LP.

Sometimes, sedation medication may be helpful for your child in order to perform the procedure. If sedation is necessary, be sure to discuss the risks and benefits with your doctor.

Helping Your Child

You can help prepare your child for a lumbar puncture by explaining that while the test might be uncomfortable, it shouldn't be painful and won't take long. Also explain the importance of lying still during the test, and let your child know that a nurse might hold him or her in place. After the procedure, make sure your child rests and follow any other instructions the doctor gives you.

If You Have Questions

It's important to understand any procedure your child undergoes. If you have questions or concerns about the lumbar puncture procedure, be sure to speak with your doctor.

Reviewed by: Yamini Durani, MD
Date reviewed: September 2011