Table 1

Initial mandatory investigations

Chest X-rayTo identify a mediastinal mass, consolidation due to infection or alveolar infiltrates suggestive of leucostasis.
Serial full blood countsAssessment of white cell count and rate of change, anaemia and thrombocytopaenia.
Serial urea, electrolytes, creatinine, bone profile and uric acidTumour lysis syndrome is characterised by hyperuricaemia hyperphosphataemia, hyperkalaemia and hypocalcaemia leading to renal injury.
Blood cultures (if indicated)Prior to staring intravenous antibiotics, blood cultures should be taken.
Group and saveIn anticipation of potential need for blood products
Clotting (prothrombin time, activated partial thromboplastin time and fibrinogen)Disseminated intravascular coagulation is occasionally seen in association with acute leukaemia.
Blood filmCan usually be examined by the on-call haematologist at the referring hospital, with a second film made and sent with the child to the PTC.
Additional EDTA samplePeripheral blood can be sent to the PTC for immunophenotyping, which may be sufficient to confirm or refute the diagnosis of leukaemia.
Viral serologyPretransfusion viral serological tests (especially VZV) are required for every child with a new diagnosis of cancer. Typically a virology screen includes VZV, HSV1, HSV2, EBV, measles, hepatitis B and hepatitis C.
  • PTC, primary treatment centre.