Correlation between initial blood count and clinical parameters in children with acute lymphoblastic leukemia

Introduction: ALL is the most common malignancy in children, accounting for one third of all pediatric cancer patients. It is of crucial importance to recognise the disease on time to ensure good outcome and prevent initial complications. Aim: Study aim was to correlate blood count and clinical parameters on diagnosis in children with ALL. Material and Methods: Retrospective study included 132 children, diagnosed and treated according to current BFM protocols. Initial blood analysis included leukocyte count (WBC), hemoglobin level (Hgb), platelet count (Plt) and percent of lymphoblasts in peripheral smear. Initial clinical parameters included fever, lymphadenopathy, hepatomegaly and splenomegaly. Results: WBC ranged from 1000 - 1050000/μL, Hgb between 40 - 156 g/L and Plt from 0 - 542000/μL. More than half of the children had all three lineages affected, while CBC within reference range was found in two patients. Only seven children had normal clinical findings. In majority of patients fever, lymphadenopathy, hepatomegaly and splenomegaly was present and strongly correlated with WBC > 20000/μL, Hgb < 120 g/L and Plt < 50000/μL. Conclusion: Affection of initial laboratory parameters and variety of clinical presentations demonstrate the diverse onset of acute lymphoblastic leukemia (ALL). Majority of patients have either clinical features or complete blood count values raising suspicion of ALL, but we point out to the patients with findings within the reference range. To the best of our knowledge we are the first to present data on initial CBC and clinical findings in children with ALL in Serbia. We stress the importance of early recognition of signs and symptoms in children with ALL.