Leukemia Symptoms

Leukemia Symptoms

This article describes the common symptoms that occur with leukemia. Leukemia is a broad category of diseases with at least 50 different subtypes. They share in common a dysfunction of the bone marrow and production of immature white blood cells. Despite the many different kinds of leukemias, they tend to cause similar symptoms. The symptoms of leukemia are also quite non-specific. These symptoms may be present with many other conditions that are not leukemia. Certain “red flag” symptoms that will be emphasized are quite abnormal and should prompt investigation for the cause.

Leukemia is among the top ten causes of cancer related death for both men and women in the United States. Leukemia is also the 9th most common cause of cancer among males in the United States. Overall, about 90% of leukemia diagnoses are in adults. Leukemia is relatively more common in children and represents about 30% of all cancers in children < 15 years of age. As noted, there are many different kinds of leukemia that include:

  • Acute lymphocytic leukemia
  • Acute myeloid leukemia
  • Chronic myeloid leukemia
  • Juvenile myelomonocytic leukemia
  • Many different subtypes of the above and other rarer forms

The function of the bone marrow and types of cells produced were described in a previous article. Acute leukemias occur when the stem cells of the bone marrow produce immature white blood cells in an uncontrolled manner. These immature cells crowd the bone marrow and prevent its normal function. Loss of normal bone marrow function creates dysfunction of its usual major products; white blood cells, red blood cells and platelets. As these immature white blood cells accumulate in numbers, they eventually spill out into the blood stream and then crowd the blood, lymph nodes, spleen and other bodily organs. Chronic leukemias differ because they come on slowly and symptoms are less abrupt. There is still overproduction of abnormal white blood cells. There are also overlaps of these two disease spectrums. Dysfunction of one or all of the key bone marrow products (i.e. platelets, red blood cells, white blood cells) characterizes the key symptoms of leukemia.

When these concerning symptoms occur, investigation should help determine the cause of these. The most common testing will involve analysis of blood counts. If leukemia is suspected, a sample of bone marrow is usually obtained.

Common symptoms of leukemia include:

  • Anemia: Anemia is not a symptom per se, but is a common finding with leukemia. The symptoms that are associated with anemia will occur with any anemia and are not specific to leukemia. Anemia refers to a low red blood cell count. The usual amount of red blood cells is about 5,000,000 per microliter of blood. It is more common to express red blood cell count by hemoglobin density or overall blood density known as hematocrit. The average normal hematocrit is about 40%. Red blood cells are responsible for transporting oxygen to the rest of the body. A lack of oxygen delivery causes a pale color to the skin and lack of energy. Anemia can cause severe fatigue, headache, paleness of skin, and over time lead to heart failure. Severe anemia can cause passing out spells, coma or death. Anemia might be the result of many different kinds of diseases or injury. Even with blood loss from an injury, the body normally is able to regenerate its supply via forming new red blood cells.

A very common cause of anemia is iron deficiency from poor nutrition. Young women are often mildly anemic from menstrual blood losses. The finding of anemia and signs of it are never normal and should be brought to the attention of your doctor. The cause of the anemia should be investigated. Despite many causes, the symptoms of anemia are similar and may be easy to recognize. If the anemia comes on very slowly, the body can compensate, and the only symptom may be fatigue.

  • Low platelets: Low amounts of blood platelets are also called thrombocytopenia. The average platelet count is between 150,000 – 500,000 per microliter of blood. It is possible to have adequate numbers of platelets but dysfunction of them. Low platelet counts are common with leukemia as these are key products of the bone marrow. The bone marrow houses stem cells that make megakaryocytes, the “parents” of platelets. There is a very long list of potential causes for abnormal platelet counts. The symptoms of thrombocytopenia are common to all of these and should be recognizable. Low platelet counts cause bleeding gums, nose bleeds, easy bruising also called ecchymosis, easy bleeding, prolonged bleeding from minor injury, pin-point bleeding of the skin called petechiae, and sometimes bleeding into joints known as hemarthrosis. Similar symptoms also occur with clotting disorders as types of hemophilia. These are considered “red flag” symptoms and whatever the cause they should be investigated.
  • Loss of normal white blood cell function: Over-production of immature white blood cells or loss of adequate white blood cell numbers / function will produce similar symptoms. There are many causes of white blood cell dysfunction. The more severe forms of leukemia, such as acute lymphoblastic leukemia, cause severe deficits of normal white blood cells. The immature white blood cells, although numerous, do not perform the normal immune system duties. Symptoms of inadequate white blood cells include frequent, severe or unusual infections.
  • Other symptoms of leukemia are the result of the unchecked over-production of immature white blood cells. Bone and joint pain can occur from infiltration of these abnormal cells. Pain and dysfunction in other organs such as the spleen can occur. Severe neurologic symptoms can arise from involvement of the central nervous system (i.e. the brain or spinal cord).

REFERENCES:

  1. www.nlm.nih.gov/medlineplus/acutelymphocyticleukemia.html
  2. www.cancer.gov/cancertopics/types/leukemia
  3. www.nlm.nih.gov/medlineplus/leukemia.html
  4. www.cancer.gov/cancertopics/pdq/treatment/CLL/patient/
  5. Abeloff, M.D. (2008). Abeloff: Abeloff’sClinical Oncology, 4th ed. Chapter 101. Philadelphia, PA: Churchill Livingstone – Elsevier
  6. Goldman, L ; Schafer A.I. (2011). Goldman: Goldman’s Cecil Medicine, 24th ed. Chapter 189, 190. New York, NY: Elsevier Saunders.
  7. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.