Inicijalna prezentacija i zbrinjavanje akutne leukemije u djece
DOI:
https://doi.org/10.13112/pc.1004Ključne riječi:
LEUKEMIJA, LIMFOBLASTIČNA; LEUKEMIJA, MIJELOIČNA; DJECA; SIMPTOMI I ZNAKOVISažetak
Uvod: Osim suvremenih kemoterapijskih protokola i poboljšanog suportivnog liječenja, odličnom ishodu zbrinjavanja akutne leukemije (AL) u djece pridonosi adekvatno prepoznavanje inicijalne prezentacije bolesti te pravodobno započeti dijagnostičko-terapijski koraci.
Metode: Da bi utvrdili kliničke i laboratorijske karakteristike pedijatrijske AL te vrijeme proteklo od hospitalizacije do diferentne obrade i početka liječenja, provedeno je retrospektivno istraživanje u Klinici za dječje bolesti Zagreb, u djece i adolescenata s novodijagnosticiranom akutnom limfoblastičnom (ALL) i akutnom mijeloičnom leukemijom (AML) u razdoblju 2017.-2021. godine. Prikupljeni su demografski (dob, spol) i klinički (simptomi i znakovi, somatski status, dijagnoza, ishod) podaci te laboratorijski nalazi. Zabilježeni su datumi prijema, hematološke obrade i početka kemoterapije.
Rezultati: U petogodišnjem razdoblju u 32 djece dijagnosticirana je AL (53 % djevojčica, medijan dobi 4.5 godina), od čega 81 % ALL (54 % djevojčica, medijan 4 godina) i u 6 pacijenata AML (50 % djevojčica, medijan 10 godina). Najčešći simptomi AL-a bili su bljedoća (66 %), slabost i malaksalost (56 %) te kožna/sluznička krvarenja (50 %), koja su ujedno najčešći klinički znak uz organomegaliju. Dominantno odstupanje u krvnoj slici svih ispitanika bilo je anemija (88 %), a pancitopenija prisutna u četvrtine (medijan hemoglobina 76 g/L, trombocita 81.5 × 109/L, leukocita 6.73 × 109/L). Prosječno vrijeme do diferentne dijagnostike iznosilo je 2 dana (podjednako za ALL i AML), uz dodatno 1 dan za ALL i 2 dana za AML do početka liječenja.
Zaključci: Inicijalna klinička prezentacija AL-a u djece, iako nespecifična, u kombinaciji s karakterističnim laboratorijskim odstupanjima u iskusnih kliničara rano pobuđuje sumnju na maligno hematološko zbivanje, što pridonosi pravodobnom započinjanju dijagnostičko-terapijskog postupka.
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