To investigate the factors that indicate the requirement of a bone marrow study for a diagnosis of acute leukemia in children with bone and joint pain.

170 children less than sixteen years old were diagnosed with acute leukemia. Eighteen (11%) of these patients, whose presenting complaints were pain in the extremities and back, were included in this study. The laboratory tests, radiographs and bone scan of patients were reviewed to identify the diagnostic clues that would indicate the need to perform a bone marrow study.

The mean age of the patients at the time of diagnosis was 6.8 years. The CBC test revealed abnormal findings such as anemia, leukocytosis/leukocytopenia or thrombocytosis/thrombocytopenia in 15 patients. The peripheral blood smear revealed immature blast cells in 14 patients. In the remaining 4 patients, MRI and bone scan revealed diagnostic clues of a hematological malignancy that indicated the need for a bone marrow study. Based on these diagnostic clues, a bone marrow study was performed to confirm acute leukemia.

Orthopedic surgeons must have high index of suspicion of acute leukemia in children with atypical bone and joint pain. A complete blood count and peripheral blood smear may be used as a screening test, and MRI may be helpful for diagnosing acute leukemia.