After completing this article, readers should be able to:

A 6-year-old boy who has Down syndrome presents with a 2-day history of fever (temperature to 39.0°C) and a painful limp and favoring of his right leg. During the past 2 weeks, he has had decreased appetite, increased pallor, and increased bruises on his upper and lower extremities. Physical examination reveals pallor and multiple ecchymoses on his arms, legs, and trunk. Bilateral cervical and supraclavicular lymph nodes are palpable; the nodes are firm, nontender, and 1 to 2 cm in size. The liver is palpable 3 cm below the right costal margin, and the spleen is palpable 2 cm below the left costal margin. Tenderness is elicited over the right distal femur. Radiographs of the right distal femur reveal osteopenia plus a small lytic lesion. A chest radiograph shows normal results with no mediastinal mass or pulmonary infiltrate. His white blood...

You do not currently have access to this content.