Dawaa Reference

chronic

Leukaemia

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Acute Lymphocytic Leukemia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459149/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD25.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against3 documents
  • No dose - referral pathway, no medicine given in primary care
  • Leukaemia - disease-level clinical article (leukaemia-full.txt)
  • Leukaemia - disease-level clinical article (leukaemia-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • Fever, tiredness, and a bleeding tendency are typical early acute leukaemia complaints [bleeding tendency · fatigue · fever]
  • Anaemia can cause breathlessness, and a low platelet count causes easy bruising or excess bleeding [anaemia · bleeding · breathlessness · bruising]
  • Acute promyelocytic leukaemia can present with gum bleeding, nosebleeds, or heavy menstrual bleeding from a coagulation disorder [abnormal uterine bleeding · gum bleeding · heavy periods · nosebleed]
  • Many chronic leukaemia patients have no symptoms and are found only from an incidentally raised white count on routine bloodwork
  • None of the symptoms is specific: fever, fatigue, weight loss, then bone pain, bruising or bleeding [bleeding · bone pain · bruising · fatigue · fever · weight loss]
  • Acute lymphoblastic leukaemia is the childhood one: up to 80% of leukaemias in children, against 20% of cases in adults
  • Chronic lymphocytic leukaemia mostly turns up between 60 and 70 years of age
  • Inherited risk sits with Klinefelter and Down syndromes, with Bloom syndrome, and with the telomeropathies - Fanconi anaemia, dyskeratosis congenita, Shwachman-Diamond [anaemia]
  • Acquired risk sits with Epstein-Barr and human T-lymphotropic virus, with ionizing radiation and radiotherapy, with benzene at work, with smoking, and with chemotherapy already given

Signs — what you find (2)

  • Bone and spine pain, plus an enlarged liver/spleen and swollen nodes, can point toward acute leukaemia [hepatomegaly]
  • An enlarged liver, spleen, and lymph nodes can occur in chronic leukaemia too, but bruising and bleeding are less common than in the acute forms [bleeding · bruising · hepatomegaly]

Tests (7)

  • Initial workup is a full blood count, metabolic panel, liver tests, and clotting studies, followed by a blood film and bone marrow sampling
  • AML can occasionally be spotted on the smear alone by needle-like Auer rods inside the leukaemic cells
  • Flow cytometry, cytogenetics, and FISH are usually needed to pin down the exact subtype
  • Acute leukaemia usually needs a bone marrow biopsy, while chronic forms can often be diagnosed from blood alone
  • CML is confirmed by finding the BCR-ABL fusion protein on peripheral blood FISH testing
  • CLL is confirmed by a monoclonal B-cell population found on peripheral blood flow cytometry
  • Blasts are 1% to 5% of marrow cells normally; above 20% on the blood film or in the marrow the leukaemia is acute, below 20% it is chronic

If not this — what else fits (5)

  • Vitamin B12 or folate deficiency can cause similar blood count abnormalities
  • Copper deficiency is another mimicker of abnormal blood counts
  • Viral infections such as HIV, CMV, or EBV can mimic leukaemia's blood picture
  • Drugs such as chemotherapy agents, valproic acid, ganciclovir, or mycophenolate can alter the blood count
  • Autoimmune disease such as lupus is on the differential for blood count abnormalities

SourceStatPearls "Leukemia" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Diagnosis and treatment (chemotherapy) require urgent haematology referral; a GP recognises the pattern from a full blood count and clinical picture and refers urgently rather than prescribing. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Diagnosis and treatment (chemotherapy) require urgent haematology referral; a GP recognises the pattern from a full blood count and clinical picture and refers urgently rather than prescribing.

Cautions
  • RED FLAG - Tumour lysis syndrome (hyperkalaemia, hyperuricaemia, acute renal failure): assess urgently and refer.
  • RED FLAG - Febrile neutropenia requiring immediate broad-spectrum intravenous antibiotic coverage: assess urgently and refer.
  • RED FLAG - Hyperleukocytosis and leukostasis syndrome (dyspnea, confusion, neurological deficits, visual changes): assess urgently and refer.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Febrile neutropenia in an immunosuppressed patient demands immediate evaluation and broad-spectrum antibiotics.
  • RED FLAG - Disseminated Intravascular Coagulation (DIC) causes thrombosis and hemorrhage and is a severe complication of leukemia, especially APL.
  • RED FLAG - Unexplained bruising or bleeding, pallor and fatigue, recurrent or severe infections, bone pain, hepatosplenomegaly, or a very abnormal white cell count on CBC.

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