Differential Diagnosis for Childhood Leukemia

The following differential diagnosis is based on the provided options and their consistency with childhood leukemia.

• Single most likely diagnosis

  • D. Leukopenia with 90% blasts: This option is most consistent with childhood leukemia, particularly acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). The presence of a high percentage of blasts in the peripheral blood is a hallmark of leukemia.

• Other Likely diagnoses

  • B. Lymphocytosis with normal morphology but increased smudge cells: While not as specific as option D, lymphocytosis with increased smudge cells can be seen in chronic lymphocytic leukemia (CLL) or other lymphoproliferative disorders. However, in the context of childhood leukemia, this presentation is less typical.
  • A. Hypogranular neutrophils and pelgeroid nuclei, an occasional blast in the peripheral blood, with increased RBC poikilocytosis: This option could suggest a myelodysplastic syndrome or a leukemic process, but it is less specific for childhood leukemia compared to option D.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Infections (e.g., sepsis) or severe bone marrow failure syndromes that could present with leukopenia or blasts in the peripheral blood. These conditions, although not directly related to leukemia, require immediate attention due to their potential severity.
  • Aplastic anemia or other bone marrow failure syndromes that could present with leukopenia and might be considered in the differential diagnosis of childhood leukemia.

• Rare diagnoses

  • Myelodysplastic syndromes or myeloproliferative neoplasms, which can present with abnormal blood cell morphology and occasional blasts, but are less common in children.
  • Lymphoma with leukemic phase, which could present with lymphocytosis and abnormal cells in the peripheral blood, but is less typical for childhood leukemia compared to the other options.