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Grade 4 very severe hypertriglyceridaemia at diagnosis in a child with acute lymphoblastic leukaemia
  1. Sanjeev Khera1,
  2. Ravi Kapoor2,
  3. Shyam Sunder1 and
  4. Deepti Mahajan1
  1. 1Pediatrics, Army Hospital Research and Referral, New Delhi, India
  2. 2Pathology, Army Hospital Research and Referral, New Delhi, India
  1. Correspondence to Dr Sanjeev Khera; kherakherakhera{at}


Dyslipidaemia is seen in nearly all cases of acute lymphoblastic leukaemia (ALL) at diagnosis, with mild hypertriglyceridaemia (HTG) in 61% and reduced high-density lipoprotein in 98% cases. HTG irrespective of severity is due to metabolic derangements associated with tumour cells turnover in haematological malignancies and is generally self-limiting. Very severe HTG with overt lipaemic serum is extremely rare at presentation in ALL. HTG is complicated by thrombosis, osteonecrosis and pancreatitis during induction chemotherapy for ALL with steroids and L-asparginase. A careful monitoring is required during induction chemotherapy in ALL when severe HTG is present at diagnosis. We present a female toddler with ALL, who presented with very severe HTG and grossly lipaemic serum. Her very severe HTG decreased to mildly raised HTG at the end of first week of induction chemotherapy. There was no further complication noticed during induction therapy.

  • haematology (incl blood transfusion)
  • malignant and benign haematology

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  • Contributors SK conceptualised, did literature review, written manuscript and involved in the diagnosis and management of the case. RK, SS and DM were involved in the diagnosis and management of the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.