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.

Aspiration and Biopsy: Bone Marrow

What It Is

Bone marrow aspirations and biopsies are performed to examine bone marrow, the spongy liquid part of the bone where blood cells are made.

In a bone marrow aspiration, a small amount of liquid marrow is taken from inside the bone so the cells can be examined under a microscope.

In a bone marrow biopsy, a small piece of intact bone marrow is removed so the structure of the bone marrow inside its bony framework can be examined. Occasionally, only an aspiration is needed; other times, both tests are done.

The aspiration and biopsy are done by a trained medical practitioner (nurse or doctor) using a small needle inserted into a bone. Usually the back of the hipbone (iliac crest) is used.

Why It's Done

Doctors perform bone marrow aspirations and biopsies when they're concerned about a problem in the bone marrow. They can help to diagnose:

  • the cause of anemia (too few red blood cells, which carry oxygen through the body)
  • the cause of thrombocytopenia (too few platelets, which help the blood to clot)
  • the cause of an abnormal number of white blood cells, which fight infections
  • cancers of the blood, such as leukemia
  • whether cancers that started elsewhere have spread to the bone marrow (the assessment of how much a cancer has spread is called staging, and is important in determining treatment and prognosis)
  • viral, bacterial, or fungal infections in the bone marrow that might be causing persistent fever or other symptoms
  • certain genetic diseases (such as lipid storage diseases)

They also may be done to collect a bone marrow sample for procedures (such as stem cell transplantation) or other testing (such as chromosomal analysis).


After the procedure is explained and all of your questions have been answered, you'll be asked to sign an informed consent form for your child — this states that you understand the procedure and its risks, benefits, and alternatives and give your permission for it to be performed.

The person performing the bone marrow aspiration and biopsy will know your child's medical history, but might ask additional questions, such as what medicines your child is taking or whether he or she has any allergies. Be sure to report any bleeding tendencies in your child, and whether your daughter might be pregnant.

Numbing cream may be placed on the aspiration and biopsy site about 30 minutes before the procedure. Your child will probably receive sedation just before the procedure begins. He or she will be asked to stop eating and drinking at a certain point earlier to make sure the stomach is empty. Sedation medications are usually given through an IV line (intravenous line) and help patients stay asleep during the entire procedure.

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


A bone marrow aspiration and biopsy usually takes about 30 minutes.

Your child may be asked to change into a cloth gown, and then will be positioned on an exam table on the stomach or side, and the skin will be cleaned with a special antiseptic soap. This will sterilize the skin.

If your child is sedated, the vital signs (heart rate, blood pressure, temperature, and blood oxygen level) will be monitored during the procedure. Your child may have a blood pressure cuff around the upper arm and a small fingertip probe to monitor the blood oxygen level.

A small amount of anesthetic medicine will be injected through the numb spot on the skin to prevent pain as the bone marrow needle is inserted through the skin and soft tissues.

For the bone marrow aspiration, the doctor or nurse will carefully insert a needle into the biopsy site and will then attach a syringe to draw out a sample of fluid from inside the bone.

For the biopsy, a different kind of needle will be inserted into the same area to remove a small sample of bone. A bandage will then be applied to the biopsy site.


What to Expect

If your child is drowsy, the injected anesthetic may sting a bit for a minute or two and he or she might also feel the pressure of the biopsy needle pushing in. Some kids feel a quick sharp cramp as the liquid bone marrow is withdrawn for the aspiration or as the sample of bone marrow is removed for the biopsy. This cramp only lasts for a few seconds. In many cases, sedation is to put children into a deep sleep so they won't feel anything.

Depending on the doctor's recommendations, your child might have to lie down for a while after the procedure. If sedated, your child may need a few hours to rest and to allow the medications to wear off.

The biopsy site may feel slightly sore the day after the procedure and might have a small bruise. The bandage should be left in place for as long as instructed by the doctor.

Getting the Results

A doctor with expertise in interpreting bone marrow biopsies (also called a pathologist) will look at the biopsy sample under a microscope and then give the information to your doctor, who will review the results with you.

In an emergency, the results of a biopsy can be available quickly. Otherwise, they're usually ready in 1-2 days. Results can't be given directly to the patient or family at the time of the test.

If a bacterial infection is suspected, a culture is sent to a lab and results are usually available in 48 hours. A doctor may start antibiotic treatment while waiting for the results of the culture.


A bone marrow biopsy is considered a safe procedure with minimal risks. Complications are rare. In some instances, there may some discomfort or pain at the biopsy site for 1-2 days. In rare cases, infection or bleeding can occur.

If your child is sedated, there's a slight chance of reaction to the medication such as allergic reaction, or slowed breathing due to the medications. If there are any problems with the sedation, the medical staff will treat them right away.

Helping Your Child

You can help prepare your child for a bone marrow aspiration or biopsy by explaining that while the test might be uncomfortable, it won't take long. Explain the procedure in simple language, and make sure the child understands where on his or her body the biopsy will be performed. After the procedure, follow any instructions the doctor gives you.

If You Have Questions

If you have questions about the bone marrow aspiration and biopsy, you can speak with your nurse or doctor before the procedure.

Reviewed by: Yamini Durani, MD
Date reviewed: April 2012