Snapshot A 11-year-old girl with Down syndrome presents with a few weeks of low-grade fever. She is otherwise feeling well, with no signs of infection. Blood-work shows elevated WBCs, low neutrophil count, and anemia. Blood cultures are drawn and come back positive for Pseudomonas. Introduction ALL Blood Smear Acute leukemia of lymphoid precursor cells that occurs in children Crowding of bone marrow leads to bone marrow failure Subtypes login to view 8 more bullets Epidemiology login to view 2 more bullets Associated conditions login to view 2 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 3 more bullets Evaluation Peripheral blood smear login to view 1 more bullet CBC reflects bone marrow failure login to view 3 more bullets Bone marrow aspiration with cytogenetics login to view 10 more bullets Differential Diagnosis AML B-cell lymphoma Non-hodgkin lymphoma Treatment Chemotherapy Prophylaxis to CNS (standard chemotherapy does not penetrate blood-brain barrier) login to view 1 more bullet Prognosis, Prevention, and Complications Prognosis login to view 1 more bullet Complications login to view 1 more bullet