1. History and examination to look for obvious causes |
2. Early biopsy* of most abnormal node for children with: - Supraclavicular nodes
- Massively enlarged nodes (ie, >4 cm [1.6 inches])
- Group of nodes with a total diameter >3 cm (1.2 inches)
|
3. Initial testing typically includes: - CBC with differential, ESR/CRP
- LDH
- Serology for CMV and EBV
- Serology for other viral illnesses as warranted by the history and examination¶
- TST
- Chest radiograph
|
4. Provide treatment or additional evaluation as indicated for conditions that are identified through initial history, examination, and testing |
5. When the cause remains uncertain after the initial evaluation, obtain the following second-tier tests if there are indications based on the initial evaluation¶: - Serology for Bartonella henselae, toxoplasmosis, histoplasmosis, coccidiomycosis, brucellosis, syphilis, HIV, and other viruses
- ANA
|
5. Obtain biopsy* of the most abnormal node within 4 weeks of initial evaluation if: - Any lymph nodes increase in size
- There is a lymph node ≥2 cm (0.8 inches) in diameter and either of the following:
- The diagnosis remains uncertain after 4 weeks
- There is no response to therapy as indicated by the findings of initial or second-tier tests
|