Health Providers

Health Providers

Risks of Corticosteroid Administration Before Diagnosis in Children With Suspected Hematologic Malignancies: A Clinical Warning

Articles in Press

Document Type : Letter to the Editor

Author
Amir Hesabi
Pediatric Hematology and Oncology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
10.22034/hp.2026.605203.1103
Abstract
Childhood hematologic malignancies, particularly acute lymphoblastic leukemia (ALL) and lymphomas, may present with nonspecific symptoms such as fever, pallor, fatigue, bone or limb pain, bruising, petechiae, lymphadenopathy, hepatosplenomegaly, or cytopenias, often mimicking benign infectious, rheumatologic, or immune conditions. Empirical systemic corticosteroid administration before completion of the diagnostic evaluation may mask symptoms, reduce circulating blasts, delay diagnosis and referral, and compromise diagnostic tissue yield in suspected lymphoma. In children with a high tumor burden, corticosteroid-induced cell lysis may also precipitate tumor lysis syndrome. Children with red-flag features should undergo prompt complete blood count with differential, peripheral blood smear examination, and timely referral to pediatric hematology-oncology before corticosteroid initiation. This caution does not apply to life-threatening emergencies or protocol-directed steroid prephase therapy after diagnostic confirmation.
Keywords
Acute lymphoblastic leukemia
Corticosteroids
Delayed diagnosis
Hematologic neoplasms
Pediatric oncology
Health Providers

Articles in Press, Accepted Manuscript
Available Online from 30 September 2026