.

The compensatory erythroid hyperplasia may give rise to folate deficiency, with megaloblastic blood features.

March hemoglobinuria is when vigorous exercise, such as prolonged marching or marathon running, can cause red cell damage and hemolysis in the capillaries of the feet.

Meningitis : inflammation of the meninges.

Blood examination usually shows anemia with a normal or raised MCV. The leukocyte count may vary from as low as 1×10^9/L to as high as 500×10^9/L or more. In the majority of patients, the count is below 100 × 10^9/L. Severe thrombocytopenia is usual but not invariable. Frequently, blast cells are seen in the blood film but sometimes the blast cells may be infrequent or absent. A bone marrow examination will confirm the diagnosis.
The bone marrow is usually hypercellular, with replacement of normal elements by leukemic blast cells in varying degrees (but more than 20% of the cells). The presence of Auer rods in the cytoplasm of blast cells indicates a myeloblastic type of leukemia.

Management:
The first decision must be whether or not to give specific treatment to attempt to achieve remission. This is generally aggressive, has numerous side-effects, and may not be appropriate for the very elderly or patients with serious comorbidities. In these patients, supportive treatment can effect considerable improvement in well-being.

There are 3 phases of the specific therapy for acute leukemia:

• Remission induction: remission is induced via a combination chemotherapy which causes severe bone marrow hypoplasia that lasts about 3-4 weeks and requires intensive support.

• Remission consolidation: more courses of chemotherapy, and more hypoplasia. Sometimes this phase includes allogeneic HSCT (Hematopoietic Stem Cell Transplant).

• Remission maintenance: this is done in outpatient setting and may last for 3 years.

قبل العلاج أكو preparations لازم تسويها للمريض، ذني يتضمنن:

• Identification and treatment of existing infections.
• Insertion of a central venous catheter to facilitate delivery of chemotherapy, fluids, and blood products.
• Correction of anemia and thrombocytopenia.
• Assessment and prevention of tumor-lysis syndrome (by using allopurinol or rasburicase).

.

Rasburicase

A common cause of abdominal pain in children, intussusception is suggested readily in pediatric practice based on a classic triad of signs and symptoms: vomiting, abdominal pain, and passage of blood per rectum.

Lethargy can be the sole presenting symptom of intussusception, which makes the condition’s diagnosis challenging

The recurrence rate of intussusception after nonoperative reduction is usually less than 10% but has been reported to be as high as 15%. Most intussusceptions recur within 72 hours of the initial event.

X-ray is only 60% sensitive in such cases. U/S is more reliable (some studies suggest a sensitivity & specificity of more than 95%). But barium enema is usually the most reliable.

The hallmark physical findings in intussusception are a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign). This mass is hard to detect and is best palpated between spasms of colic, when the infant is quiet. Abdominal distention frequently is found if obstruction is complete.

Patients with intussusception often have no classic signs and symptoms, which can lead to an unfortunate delay in diagnosis and disastrous consequences.
Maintaining a high index of suspicion for intussusception is essential when evaluating a child younger than 5 years who presents with abdominal pain or when evaluating a child with Henoch-Schönlein Purpura or hematologic disorders.