Pitfalls
- The clinical symptoms of leukaemia overlap with a myriad of other conditions. Often the picture seen in the emergency department is of bi- or pan-cytopaenia with non-specific symptoms such as fever, malaise, bruising and lethargy. It is important to consider leukaemia in these patients, but also remember there are a number of more likely causes (such as B12 deficiency).
- Ruling out acute leukaemia by a blood film. Leukaemia cannot be ruled out by an absence of blasts on the blood film. If in doubt, discussion with haematology is advised.
- Attributing fever to leukaemia rather than infection. Leukaemia as a primary cause of fever is rare, and the consequences of not treating infection are disastrous. In all leukaemia patients, fever should be presumed due to infection and treated as such until proven otherwise.
- Assuming that a patient who has had multiple rounds of chemotherapy has a poor prognosis. In acute leukaemia, chemotherapy regimens are designed to have multiple courses in order to maximise the chance of cure. Multiple previous treatments do not necessarily reflect prior treatment failure or disease progression.
- Some chronic haematological disorders can transform into acute leukaemia. If the clinical picture fits, then consider acute leukaemia even where a patient comes with a label of an alternative haematological illness.