Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Leukemia and Lymphoma

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In one line

·Leukemia is when one white blood cell in the bone marrow loses its growth controls and multiplies out of control, crowding out normal blood cells.

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Normal physiology

·Bone marrow (the spongy factory inside your bones) makes red cells, white cells, and platelets in perfect balance every day. Lymph nodes (tiny bean-shaped filters scattered throughout your body) catch germs and help white cells do their job. Lymphocytes (one kind of white cell) grow up in the marrow, travel through blood and lymph fluid, patrol for invaders, and die on schedule when they are old. Keep that picture in your head, because every weird finding only makes sense when you see it as a change from normal.

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What goes wrong

·One cell in the bone marrow or a lymph node picks up a DNA mistake (mutation) that breaks its growth controls. Instead of growing up, working, and dying on schedule, it keeps copying itself forever, like a factory machine stuck in the 'on' position. That one broken cell becomes two, then four, then millions, crowding out normal cells and stealing their space and food.

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Hallmark signs

·Swollen lymph nodes that don't hurt
·Fever that comes and goes without any infection
·Soaking night sweats that drench your clothes and sheets
·Losing more than 10 percent of your body weight without trying
·Feeling exhausted all the time
·Easy bruising or tiny red or purple dots on the skin
·Getting infections over and over
·Belly pain or feeling full fast when you eat

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Red flags · escalate now

·Fever, drenching night sweats, and losing more than 10 percent of your body weight in six months (called B symptoms — they mean the cancer is more aggressive)
·Trouble breathing, chest pain, or swelling in the face and neck (the cancer may be pressing on the big veins or windpipe in the chest)
·Sudden severe confusion, headache, or weakness on one side of the body (cancer may have spread to the brain or spinal cord)
·Bleeding that won't stop or bruises appearing all over without any injury (platelet count is dangerously low)
·Severe belly pain with a hard, swollen abdomen (the spleen or liver may be hugely enlarged or rupturing)

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Workup

·Complete blood count (CBC) with differential
·Peripheral blood smear
·Bone marrow biopsy with flow cytometry
·Cytogenetics and molecular testing (FISH, PCR for gene mutations)
·Chest X-ray or CT chest
·Metabolic panel (potassium, phosphate, uric acid, creatinine, calcium, LDH)
·PET-CT scan (for lymphoma staging)
·Lumbar puncture (spinal tap) with cerebrospinal fluid analysis

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Treatment

·IV fluids (150–200 mL/kg/day), allopurinol (or rasburicase in high-risk patients), and continuous heart monitoring
·Leukapheresis (machine that spins extra white cells out of the blood) if symptomatic hyperleukocytosis is present
·Disease-specific chemotherapy regimen matched to cancer type and genetic markers: APL gets all-trans retinoic acid (ATRA) and arsenic trioxide; AML gets cytarabine + anthracycline (7+3 regimen); ALL gets multi-agent induction (vincristine, daunorubicin, asparaginase, steroid); diffuse large B-cell lymphoma (DLBCL) gets rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP); Hodgkin lymphoma gets doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD); chronic lymphocytic leukemia (CLL) gets BTK inhibitors (ibrutinib) or BCL-2 inhibitors (venetoclax)
·Blood product transfusions (packed red cells for anemia, platelets for bleeding) and growth factors (G-CSF for severe dangerously low infection-fighting cells (neutropenia))
·Infection prevention (prophylaxis): antibacterial (levofloxacin or cefepime if feverish (febrile) dangerously low infection-fighting cells (neutropenia)), antiviral (acyclovir for herpes simplex virus), antifungal (fluconazole or posaconazole), and Pneumocystis jirovecii pneumonia (PCP) prevention (trimethoprim-sulfamethoxazole)
·Intrathecal chemotherapy (methotrexate or cytarabine injected into spinal fluid) for CNS prevention (prophylaxis) or treatment
·Hematopoietic stem cell transplant (bone marrow transplant) in selected patients with high-risk disease, relapsed disease, or in first remission for certain types (e.g., AML with poor-risk genetics)

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NCLEX trap

·Make the patient safe first — help them breathe if they cannot, check their ABCs. Then figure out what is wrong: get a complete blood count and bone marrow biopsy to see what type of leukemia and how bad the counts are. Only after you know the baseline white count and the exact type of leukemia should you start antibiotics. If you give the wrong antibiotic too early, you can hide the real problem or cover up tumor lysis syndrome. The order matters: airway and breathing → blood counts and diagnosis → targeted treatment.
·In leukemia with hyperleukocytosis (white count above 100,000), transfusing red blood cells can make the blood even thicker and clog small vessels in the brain and lungs — called leukostasis. Give IV fluids first to thin the blood, check the white count, and only transfuse if the patient is actively bleeding or the hemoglobin is dangerously low (usually under 7 in adults, under 6–7 in children). When you do transfuse, go slowly. Treat the white count problem (with leukapheresis or hydroxyurea) before you treat the anemia.
·Swollen lymph nodes in leukemia and lymphoma are the cancer cells themselves — they have moved into the nodes and are growing there. Draining them or biopsying them carelessly ruins the tissue you need to diagnose which exact type of cancer. Get a proper tissue biopsy (excisional or core needle, sent for flow cytometry, immunohistochemistry, and molecular tests) first, then treat the cancer with chemotherapy or targeted therapy. Antibiotics do not shrink cancer nodes.
·Tumor lysis syndrome can happen before any treatment in high-burden leukemia and lymphoma because the cancer cells are already dying on their own from growing too fast. Start prevention on day one: IV fluids (at least 2–3 liters per square meter per day in children, 150–200 mL/hour in adults), allopurinol (or rasburicase if uric acid is already high or the tumor burden is huge), put the patient on telemetry, and check labs — potassium, phosphate, calcium, uric acid, creatinine — right away and every 4–6 hours. Do not wait for symptoms like seizures or deadly heart rhythms; by then the potassium is already dangerously high.
·Shortness of breath in leukemia can be hyperleukocytosis — white count over 100,000 causing thick blood that clogs the tiny vessels in the lungs and brain — or a mediastinal mass (a tumor in the chest pressing on the windpipe or the big veins bringing blood back to the heart). Both are crash points. Oxygen alone does not fix the upstream problem. You need to lower the white count fast with leukapheresis (filtering out white cells), hydroxyurea (a pill that slows cell division), or emergency chemotherapy, and get a chest X-ray or CT to see if there is a mass. If there is a mass, the patient may need radiation or intubation in the OR by an experienced team. Treat the cause, not just the symptom.
·Each leukemia and lymphoma needs its own medicine because the biology is different. Acute promyelocytic leukemia (APL, a subtype of AML) gets all-trans retinoic acid (ATRA, which makes the cancer cells mature into normal cells) plus arsenic trioxide — not classic chemotherapy. Other AML gets 7+3 induction (cytarabine for 7 days, daunorubicin for 3 days). Acute lymphoblastic leukemia (ALL) gets multi-drug therapy with vincristine, a steroid, an anthracycline, and L-asparaginase. Diffuse large B-cell lymphoma (DLBCL) gets R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Chronic lymphocytic leukemia (CLL) often gets a BTK inhibitor like ibrutinib. The cancer type tells you the right drug — you must get the bone marrow biopsy (for leukemia) or lymph node biopsy (for lymphoma) and flow cytometry so you know exactly what you are treating.

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