The commonest hematological malignancy in children is?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Acute Lymphoblastic Leukemia (ALL) is the most prevalent childhood cancer, making up about one-fourth of all pediatric malignancies.
It accounts for approximately 75% of all new cases of leukemia diagnosed in children, making it the most common by a significant margin.
The peak incidence of ALL occurs in early childhood, specifically between the ages of 2 and 5 years.

Option B: Chronic Myeloid Leukemia (CML) is rare in the pediatric population, constituting less than 5% of all childhood leukemias.
Option C: Chronic Lymphocytic Leukemia (CLL) is almost non-existent in children and is primarily a malignancy affecting older adults.
Option D: While it is the second most common leukemia in children, Acute Myeloid Leukemia (AML) is significantly less frequent than ALL, accounting for only about 15-20% of cases.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Epidemiology of childhood leukemia as background academic context rather than a clinical decision trigger.
Nurses must be vigilant for signs of infection in children with ALL, as they are often severely neutropenic due to the disease and its treatment. Strict infection control protocols are essential.
Bleeding precautions are critical due to thrombocytopenia. This includes avoiding intramuscular injections, using soft-bristled toothbrushes, and monitoring for petechiae, purpura, and epistaxis.
What if? If a child undergoing chemotherapy for ALL suddenly develops fever, altered mental status, and electrolyte abnormalities (high potassium, high phosphate, low calcium), the nurse should suspect Tumor Lysis Syndrome (TLS). This is a medical emergency requiring immediate intervention to prevent renal failure and life-threatening arrhythmias.

How to Approach the Question

First, identify the core of the question: it asks for the 'commonest' or most frequent 'hematological malignancy' in 'children'.
This is a factual recall question based on epidemiology. Your task is to remember or determine the relative incidence of different blood cancers in the pediatric population.
Systematically evaluate the options. Recall that acute leukemias are far more common in children than chronic leukemias.
Between the two acute leukemias, ALL and AML, remember that ALL has a distinct peak in early childhood (2-5 years) and is the most prevalent by a large margin.
Eliminate CML and CLL as they are known to be rare in children and are primarily diseases of adulthood.
Conclude that ALL is the most frequent hematological malignancy in children.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 619-621, 627-629