Introduction: Congenital and neonatal leukemia rarely occur, yet carry high mortality rates and pose special problems for the obstetricians, perinatologist and hematologist. Although the etiology is unknown, the presence of leukemia at birth suggests a genetic abnormality and possible intrauterine exposure to drugs or other toxin as contributing factors.
Case Presentation: We describe a case of congenital leukemia of a baby boy born to a 26 year old multiparous mother, who, apart from being obese, had no other medical problems. The fetus was identified to be larger than gestational age at term, with an estimated birth weight of 4.5 kg, thus delivery was affected via an elective lower segment caesarean section. Sonographic examination done a day before delivery showed an abdominal circumference of 410 mm and HC:AC ratio 0.8 (low).
At birth, the baby was noted to have multiple lymphadenopathy, distended abdomen with hepatosplenomegaly and bluish cutaneous nodules. Initial full blood count of the baby was anaemic (haemoglobin level 7 g/dl), had hyperleucocytosis (total white blood cell count 412×10^9) and thrombobocytopenic (platelet count 29×10^9). A diagnosis of congenital Beta-cell acute lymphoblastic leukemia was suggested by imunophenothyping. The baby received and completed the induction phase of chemotherapy regime in the form of 6 doses of intramuscular L-asparginase (ASPA). However, there were episodes of relapses during the maintenance phase in March 2017 and he passed on at 4 months of life.
Discussion and Conclusion: Detecting congenital leukemia in the antenatal period is definitely a challenge to the obstetrician. In situations where the measurement of abdominal circumference is beyond 90th centile and the HC:AC ratio is abnormally low, hepatosplenomegaly should be suspected and further evaluation done. The middle cerebral artery Doppler study may be useful when there is severe fetal anaemia. In such situations, appropriate counseling should be done to the parents and preparation for neonatal care organized.