Clinical and laboratory characteristics of children with leukemia: a 34-year single-center experience

Leukemia is the most common childhood malignancy and often presents with nonspecific symptoms, which may lead to delays in diagnosis. Early recognition of clinical signs and laboratory abnormalities is essential to ensure timely referral and improve outcomes. This study assesses the clinical and laboratory characteristics of pediatric patients with acute and relapsed leukemia, points out key considerations during diagnosis, and investigates potential factors contributing to delayed diagnosis.

A retrospective analysis was performed on pediatric patients diagnosed with leukemia at a tertiary care hospital between the years 1986 and 2020. Early diagnosis was defined as a diagnosis made within 20 days of symptom onset.

Among the 378 patients, fatigue was the most frequently reported symptom, followed by fever and bone or joint pain. Common laboratory abnormalities included anemia (83%), thrombocytopenia (80%), and leukocytosis (46%). Bone or joint pain (p< 0.001), mucosal bleeding (p=0.013), and pallor (p=0.005) were significantly associated with late diagnosis. In contrast, lymphadenopathy (p=0.014) and bone tenderness (p=0.024) were linked to earlier recognition. Among laboratory findings, low hemoglobin levels were associated with early diagnosis (p=0.023) and elevated platelet count was also significantly related to delayed diagnosis (p=0.028). In relapsed leukemia cases, abnormal blood count findings were common, and neurological symptoms were observed more frequently compared to acute leukemia patients.

Fatigue, fever, and bone or joint pain were identified as the most common presenting symptoms in acute leukemia cases, while hepatomegaly, splenomegaly, and lymphadenopathy were the predominant physical findings. Bone or joint pain, mucosal bleeding, and pallor were associated with late diagnosis, whereas lymphadenopathy and bone tenderness appeared to facilitate earlier recognition.