Leukaemia (suspected) - investigations and initial management
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In addition to the routine investigations (see new
diagnosis -work up of the oncology patient), do the following
investigations for suspected leukaemia. Discuss enrolment on
appropriate COG biology study.
| ALL - blood for TPMT (thiopurine methyltransferase)
mutations (only done routinely in Christchurch)
|In Christchurch send for functional and genetic analysis to
Molecular Pathology Laboratory, Christchurch School of Medicine.
Auckland does this test as required only.
|VZV serology done routinely in Auckland.
|investigate and treat as for febrile neutropenic patient
regardless of the neutrophil count.
|Presentation marrows may be very difficult to aspirate and
should be done by an experienced person.
|Request microscopy, cell markers, molecular studies and cytogenetics (and any
tests required by protocols the patient may be enrolled on).
|Obtain consent to store marrow specimen indefinitely
|On aspirate slides, record initial and surname, NHI #
and date of aspirate. (Done by laboratory staff in
|Ideally obtain on all newly diagnosed patients with leukaemia.
In Auckland, trephines are done routinely only where aspiration is
|If there is any doubt as to the quality of the aspirate slides
then roll the trephine on slide, take some for tissue culture
medium and the rest in formalin. In Auckland this will be done by
the special haematology scientists.
|Ensure platelet count > 50 (for diagnostic LP) and
coagulation is within normal limits. The diagnostic sample should
be done by the most experienced person available as contamination
of the CSF with blood may be associated with CNS relapses
|Collect 10 drops in each of 3 tubes labelled 1, 2, 3, for cell
count protein/glucose and haematology cytospin. In Auckland, the
third tube is filled at least half way so specimen is available for
immunophenotyping if this is indicated.
|Delay initial LP until diagnosis is confirmed so that protocol
defined IT chemo (MTX, CYT or TIT) can be given. In practice, this
only happens if there is doubt about the diagnosis from the
peripheral blood film.
|Central venous line
|If diagnosis is established from blood results, insert at time
|It is important to know type of leukaemia because:
- AML: double lumen Hickman line
- ALL: PICC or single lumen Port initially depending on clinical
situation. A formal access will be needed later if a PICC is
inserted but this is often preferable in the acute situation due to
|Anthracyclines - obtain baseline echo for fractional
- Date last published: 09 March 2016
- Document type: Clinical Guideline
- Services responsible: National Child Cancer Network
- Author(s): Amanda Lyver, Tim Prestidge
- Owner: Amanda Lyver
- Review frequency: 2 years
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