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Differential Diagnosis




Leukemia often presents with diffuse bone pain due to multifocal bone involvement. This is more common in ALL than AML.

See differential diagnosis of multiple bone lesions

Half of the children with newly diagnosed leukemia have elevated white cell counts of more than 20,000 per mm3, but leucocytosis can be reactive.

Also leukemia can present with symptoms of bone marrow failure with

  • Anemia
  • Thrombocytopenia
  • Pancytopenia (see below)
  • White cell count may be normal or elevated.

Bone marrow aspiration is required for diagnosis.


Pancytopenia = Low red blood cell count (anemia), low white cell count and low platelet count (thrombocytopenia).

Often occurs secondary to chemotherapy and radiation therapy. It can also be due to bone marrow replacement by disease.

Differential Diagnosis the causes of Bone Marrow failure:

Idiopathic In many cases of bone marrow failure the cause is unknown
Direct Toxins Radiation
Intermediate metabolites of some common drugs
Infections Viral Hepatitis
HIV infection
Infectious Mononucleosis (Epstein-Barr virus)
Many different viral infections (for example Rubella, Parainfluenza, Measles, Mumps and Influenza)
Immunologic Disorders Graft versus host reaction in transfused immunologically incompetent subjects.
Malignancy Aplastic anemia preceding acute leukemia (hypoplastic preleukemia)
Malnutrition Kwashiorkor


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