title: Symptoms of childhood acute lymphoblastic leukemia: red flags to recognize leukemia in daily practice.
abstract: BACKGROUND
  The aim of this study is to identify clinical "red flags" that may assist the general pediatrician in detecting patients with an acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  Medical history and clinical findings of 189 children and adolescents, diagnosed with ALL between 1/1995 and 7/2004, were analyzed retrospectively.
  
  
  RESULTS
  Only 50% of patients presented with symptoms known in children with leukemia (fever, fatigue, paleness, hemorrhage); 5% were diagnosed accidentally in the absence of any clinical symptoms. The majority of patients had a medical history up to few weeks; in 11% of patients up to several months without impairing curability. 95% of the patients presented at diagnosis with enlargement of lymphnodes, liver and/or spleen. The characteristic laboratory constellation included mono-, respectively bi- or trilinear pathology of the blood count and with blasts in the blood smear.
  
  
  CONCLUSIONS
  The clinical diagnosis of ALL relies on physical examination and the blood count including microscopic examination. Therefore, the alertness of the treating paediatrician with regard to clinical findings and a pathologic blood count is more important than elaborate laboratory investigations. In uncertain cases, a close follow-up examination may help to unmask ALL, which will most likely be stratified in the low-risk-group.
authors.affiliation: Klinikum Dortmund, Westfälisches Kinderzentrum, Dortmund, Germany. Benedikt.Bernbeck@klinikumdo.de
authors.forename: B
authors.initials: B
authors.lastname: Bernbeck
authors.forename: D
authors.initials: D
authors.lastname: Wüller
authors.forename: G
authors.initials: G
authors.lastname: Janssen
authors.forename: R
authors.initials: R
authors.lastname: Wessalowski
authors.forename: U
authors.initials: U
authors.lastname: Göbel
authors.forename: D T
authors.initials: DT
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001752:Blast Crisis; D001853:Bone Marrow / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D050676:Core Binding Factor Alpha 2 Subunit / Q000235:genetics; D057210:Delayed Diagnosis; D018572:Disease-Free Survival; D005260:Female; D015973:Gene Expression Regulation, Leukemic / Q000235:genetics; D005858:Germany; D006452:Hemoglobinometry; D006529:Hepatomegaly / Q000175:diagnosis; D006801:Humans; D016130:Immunophenotyping; D033162:Incidental Findings; D007223:Infant; D007958:Leukocyte Count; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000175:diagnosis; D008297:Male; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D010372:Pediatrics; D010808:Physical Examination; D010976:Platelet Count; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D013163:Splenomegaly / Q000175:diagnosis; D000097764:ETS Translocation Variant 6 Protein
chemical_list: D000970:Antineoplastic Agents; D050676:Core Binding Factor Alpha 2 Subunit; D015514:Oncogene Proteins, Fusion; C102421:TEL-AML1 fusion protein; D000097764:ETS Translocation Variant 6 Protein