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Recognition and management of leukaemia in children

08 August 2019
20 min read
Volume 28 · Issue 15

Abstract

Leukaemia is the most common cancer in children. The presenting manifestations can be wide-ranging, from a relatively well child to life-threatening complications. Symptoms can be manifested in any of the bodily systems. Undertaking a thorough clinical assessment of the child, in addition to recognising and addressing parental concerns, is vital. Furthermore, recognising that children can commonly present with musculoskeletal or abdominal symptoms increases the diagnostic yield, thereby preventing missed or late diagnoses. Childhood cancer has a huge impact on the child and their family, both at diagnosis and in the long term; providing advice and signposting families to appropriate support groups is an important aspect of their management. Nurses play a vital role in managing children with cancers, starting from raising suspicion and identifying the child with leukaemia, ensuring that high-quality care is delivered throughout their treatment, managing complications, and providing support and information to children and their families. An illustrative case study is included to highlight some of the challenges that health professionals may encounter in their clinical practice.

Leukaemia is a type of cancer derived from any of the blood-forming cells of the bone marrow tissue, most commonly those forming into white blood cells (National Institute for Health and Care Excellence (NICE), 2016). The most common types of childhood leukaemia are acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) (Hoffbrand and Moss, 2015). Children can also be affected by chronic leukaemias such as chronic myeloid leukaemia, although this occurs far less commonly and is not addressed further in this article.

Leukaemia can present with a range of non-specific symptoms, but it can also often mimic other common and less serious self-limiting childhood conditions (Scowcroft, 2013). Thus, maintaining a suspicion, along with a focused approach, is pertinent in preventing a missed diagnosis of childhood cancer (Clarke et al, 2016). A diagnosis of childhood cancer has a significant impact on the entire family, and it is often a time of great anxiety, distress and uncertainty (Children's Cancer and Leukaemia Group, 2014a). The role of the nurse for the child and family starts with recognising the child with leukaemia, delivering high-quality care throughout their ongoing treatment, managing complications, and providing long-term support and information.

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