Dawaa Reference

Clinical reference

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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