A 5-year-old has recurrent fevers, bone pain, weight loss, scattered petechiae, lymphadenopathy, bruising, and CBC showing thrombocytopenia, anemia, and leukocytosis. The NP will refer this child to a specialist for a?

• A. Bone marrow biopsy
• B. Corticosteroids and IVIG
• C. Hemoglobin electrophoresis
• D. Immunoglobulin testing

Answer: (A)

Recognizing acute leukemia in a child is essential when there are fevers, bone pain, weight loss, petechiae, bruising, lymphadenopathy, and a CBC showing anemia, thrombocytopenia, and a abnormal white cell count. The defining step to confirm this diagnosis is a bone marrow biopsy. By examining the marrow, clinicians can identify blasts, perform immunophenotyping to classify the leukemia, and gather cytogenetic information that guides treatment. This tissue diagnosis is what differentiates leukemia from other possible causes of similar symptoms and CBC changes, making the referral for a bone marrow biopsy to pediatric hematology/oncology the most appropriate next move.

The other tests listed don’t provide the definitive diagnostic confirmation for leukemia. Hemoglobin electrophoresis screens for hemoglobinopathies, immunoglobulin testing assesses immune function, and corticosteroids with IVIG are treatments for immune-mediated conditions—not the confirmatory diagnostic step needed when leukemia is suspected.