Grand Rounds

Jaundice in a child with leukemia

Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056

Clinical Problem :
A 13 years old child presented with fever for 15 days along with jaundice. He was admitted in a hospital and detected to have pancytopenia. His Hepatitis A, B and E markers were negative. He underwent a bone marrow examination and was detected to acute lymphoblastic leukemia. He was started on steroids but the jaundice increased. His bilirubin increased from 14mg, dl to 25mg, dl with a direct bilirubin of 16mg, dl. His SGOT and SGPT were marginally elevated 110 and 130mg, dl and total proteins and Albumin were normal. Alkaline phosphatase was elevated. His stool was not clay coloured and there was no itching. Ultrasound abdomen showed hepatomegaly and Doppler of portal system was normal. His serum ferritin was 550 though Fibrinogen and triglycerides were normal.

What is the cause of jaundice in this child_?

Discussion :
Children with acute lymphoblastic leukemia {ALL} frequently present with hepatomegaly and mild liver functional impairment. Severe jaundice is a rare complication of leukemia. Jaundice could be due to liver damage due to drugs, viral infections, tumour cell infiltrations and hemolysis. In this child, since viral markers were negative and the child already had jaundice prior to start of chemotherapy, the most likely cause of jaundice in this patient is leukemic infiltration of the hepatic sinusoids. Since this child had thrombocytopenia, a transjugular liver biopsy was done and histopathology showed leukemic infiltration of the liver.

E-published: January-March 2014 Vol 11 Issue 1 Art No. 5

Correct Answers :  yes 16%
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