Role of the Non-Pediatric Oncologist in Initial Management of Newly Diagnosed ALL:
Prompt recognition of signs and symptoms suggestive of ALL.
Ordering CBC and Differential when suspicious.
Prompt phone call to pediatric oncologist at tertiary care center when CBC shows blast cells.
Urgent referral of patient to tertiary care emergency room for consultation. May include parents bringing child in by car, ambulance if child unwell, or intensive care transport if patient is far away from tertiary center.
Initial medical stabilization of patient when required. This includes:
- Insertion of peripheral intravenous catheter
- Hyperhydration with 2-3x maintenance IV fluids with no potassium
- Start allopurinol to avoid further uric acid production which can result in renal failure.
Do not prescribe steroids unless prompted to do so by pediatric oncologist for a sick patient. Will potentially affect diagnostic ability.
Discussion with patient and parent of the possibility of leukemia diagnosis and need to see pediatric oncologist.
Subsequent Evaluations by Pediatric Oncologist:
- Bone marrow aspirate
- Bone marrow biopsy
- Lumbar puncture
