In dealing with the medical aspects of international
adoption, the usual outcome is almost always a happy ending. Yes, there are
those cases where there is an underlying medical condition, developmental delay
or emotional trauma. Fortunately, most of these cases can be treated with
medications, therapy or surgery. When I treat an internationally adopted child,
I obtain the greatest professional satisfaction because I know that I made a
difference is a child’s life. I know that if this child was not adopted by their
family , their medical problems would have gone undetected, because no one
cared to look for them and more than likely their illness would have gone
Every day in my clinical practice I deal with all types of
children with variable types of medical conditions. On my website www.adoptiondoctors.com , I answer
many questions placed by worried adoptive families. This question that I am
answering today I write about with a heavy heart. As physicians we are trained
to deal with all aspects of tragedy, but rarely would a physician encounter a
case such as the one I will be describing. The topic today is about a Chinese
girl that was fortunate enough to be adopted, and was in excellent medical
health for years post adoption. She had very rarely been to the doctor’s office
other than for routine well care visits. It was not until over two after coming
home did this child become acutely ill and succumb to her death secondary to
Many people are now wondering if Leukemia is a problem
specific to children adopted from China? Is there a test that could
be performed for leukemia prior to adopting, and most importantly, does
hereditary a play a key factor in the diagnosis?
The short answer to this question is No! I feel that this
was just an unfortunate case.
Leukemia is the most common form of childhood cancer and it
generally can affect almost any child anywhere. There are some suspected risk
factors which I will mention but all in all no one can predict which child will
and which child will not get leukemia.
In this article, I will do a brief over view of leukemia in
order to help educate those worried families out there.
Usually, the leukemia is a cancer of the white blood cells,
but leukemia can involve other blood cell types as well. Leukemia starts in the
bone marrow and then spreads to the blood. From there it can go to the lymph
nodes, spleen, liver, the brain and spinal cord, testicles or other organs.
Leukemia is described as rapidly growing (acute) or slow growing (chronic).
Almost all childhood leukemia is acute.
The fast growing leukemia is divided into 2 types:
- acute lymphocytic leukemia (ALL, also called acute
- acute myelogenous leukemia (AML, also called acute myeloid
leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia (ANLL))
Leukemia is the most common cancer in children and
adolescents. It accounts for almost one third of all cancers in children under
age 15. ALL is most common in early childhood, peaking between 2 and 3 years of
age. AML is most common during the first 2 years of life and is less common
among older children. ALL is slightly more common among white children than
among African-American and Asian-American children, and is more common in boys
than in girls.
AML occurs equally among boys and girls of all races.
What Are the Risk Factors for Leukemia? A risk factor is
defined as anything that can increases a person's chance of getting a disease
such as cancer.
Genetic Risk Factors
Certain genetic or inherited diseases cause children to be
born with an abnormal or deficient immune system. In addition to developing
serious infections due to their reduced immune defenses, these children also
have an increased risk of developing leukemia.
Although these immune deficiency diseases can be passed on
to children, adult leukemia survivors who do not have these inherited diseases
do not pass an increased risk of leukemia on to their children.
There are also several other inherited disorders that
increase a child’s risk of developing leukemia:
Children with Down's syndrome (trisomy 21) have an increased
risk of developing leukemia. Children with Down's syndrome are 15 times more
likely to develop either ALL or AML than are other children.
Klinefelter’s syndrome is a genetic condition in which males
have an extra "x" chromosome. This causes infertility, prevents
normal development of male features (such as body hair, deep voice, etc.), and
is also associated with an increased risk of developing leukemia. Several other
genetic disorders (neurofibromatosis, ataxia telangectasia, Wiscott-Aldrich
Syndrome, and Fanconi’s anemia) also carry an increased risk of developing
Environmental Risk Factors
Environmental risk factors, such as radiation and certain
chemicals, in our surroundings may increase the likelihood of developing
Radiation exposure: Radiation injury is a major
environmental risk factor in developing childhood leukemia. Japanese survivors
of the atomic bomb had an increased risk of developing AML, usually within 6-8
years after exposure. Similar risks occurred after exposure to nuclear reactor
accidents. Exposure of the fetus to significant radiation within the first
months of development may also carry an increased risk of developing ALL.
Certain chemicals: Exposure to chemicals such as benzene may
cause AML in adults and, rarely, in children. ALL has not been linked to any
Other factors that have been studied for a possible
association with ALL include exposure to insecticides; mother’s age at birth;
mother’s use of alcohol, cigarettes, diethylstilbestrol (DES), or
contraceptives; father’s occupational exposure to chemicals and solvents; and
chemical contamination of ground water. Now one could say that some of these
things may be found in an orphan child’s environment, but it would not be
specific to just China,
it could be from anywhere in the world. Regardless, none of these factors has
been linked conclusively to leukemia.
Can Leukemia be prevented?
Children with a known increased risk of developing leukemia
(because of Down's syndrome, for example) should receive careful, periodic
medical checkups and at that time routine complete blood counts or CBC. The
frequency of leukemia in children with these syndromes, although greater than
in the general population, is still very rare.
Signs and Symptoms of Childhood Leukemia
Most of the signs and symptoms that children with leukemia
develop result from a lack of normal blood cells caused by crowding out of
normal blood cell-producing bone marrow by the leukemia cells. It has been my
experience that children do not just come to the office with a Diagnosis of
leukemia. They tend to have multiple visits with strange complaints. Their
illness or symptoms never completely resolve or they just get worse. The
diagnosis is usually suspected after a physician does a complete blood count
and it is discovered that the blood lines are abnormal.
Sometimes children present with repeated infections that do
not respond to antibiotics. They can have a high fever, and become very sick.
Also, some children present with vague symptoms of leg pain that is initially
diagnosed as growing pain. Leukemia is a cancer of white blood cells, children
with leukemia may have extraordinarily high white blood cell counts, but these
affected leukemic cells do not protect against infection the way normal white
blood cells do. Thus the classic case is a child with prolonged fevers that do
not respond to conventional therapy even after many days to weeks.
A child with leukemia may bruise easily or have increased
bleeding from small cuts and nosebleeds. There may be pinhead-sized red spots
on the skin that represent bleeding from tiny blood vessels. This results from
poor production of blood platelets, which are important for plugging holes in
damaged blood vessels.
Some children present with recurrent bone pain. Many times
they may be diagnosed initially with growing pain. The diagnosis again is
suspected after an abnormal CBC is performed. The pain is caused by an
accumulation of the leukemia cells underneath the covering of the surface of
the bone. Some children will also have a lack of appetite.
Unfortunately, a poor appetite is run of the mill in
Pediatrics. Leukemia often causes enlargement of the liver and spleen.
Enlargement of these organs would be noticed as a fullness, or even swelling,
of the belly. The lower ribs usually cover these organs but when they are
enlarged, the doctor can feel them.
Leukemia can also spread to lymph nodes. The child, a
parent, or a health care professional may notice swollen nodes that are close
to the surface of the body (lymph nodes on the sides of the neck, in the groin,
underarm areas, above the collarbone, etc.). Swelling of lymph nodes inside the
chest or abdomen may also occur. These are sometimes detected only by imaging
tests, such as CT or MRI scans.
Headache, seizures, vomiting: Leukemia cells can spread
outside the bone marrow. This is called "extramedullary spread." It
may involve the brain and spinal cord, the testicles, ovaries, kidneys, lungs,
heart, intestines, or other organs. Headache, poor school performance,
weakness, seizures, vomiting, difficulty in maintaining balance, and blurred vision
can be symptoms of CNS leukemia.
Rashes, fatigue, and weakness: AML can cause some unique
symptoms. Leukemia cells may spread to the gums, causing swelling, pain, and
bleeding. Spread to the skin can cause small darkly colored spots that can
resemble common rashes. One unusual but very mysterious consequence of AML is
extreme tiredness, weakness, and slurring of speech, which occurs when very
high numbers of leukemic cells make the blood too "thick" and
interfere with circulation through small blood vessels of the brain.
As you can see, leukemia is a very difficult diagnosis to
predict. Suspicion for this illness should be made when a child presents with
what appears to be vague or mysterious signs and symptoms that do not resolve
after the routine time frame. The suspicion is generally made after a good
history and physical examination is performed followed by a complete blood cell
count. The definitive diagnosis is made by a bone marrow aspiration.
Written By George Rogu
M.D. Medical Director and Founder of Adoptiondoctors.com
The information and advice provided is intended to be
general information, NOT as advice on how to deal with a particular child's
situation and or problem. If your child has a specific problem you need to ask
your pediatrician about it - only after a careful history and physical exam can
edical diagnosis and/or treatment plan be made. This Web
site does not constitute a physician-patient relationship.