From the Guidelines
Common signs of leukemia on physical examination include pallor due to anemia, petechiae or ecchymoses from thrombocytopenia, and lymphadenopathy (enlarged lymph nodes) particularly in the cervical, axillary, and inguinal regions. Patients may present with hepatomegaly and splenomegaly as leukemic cells infiltrate these organs, with splenomegaly being the most consistent physical sign detected in 40%–50% of cases 1. Bone tenderness, especially over the sternum or long bones, can occur due to bone marrow expansion. Gingival hypertrophy and bleeding are sometimes seen, particularly in acute monocytic leukemia. Skin manifestations may include leukemia cutis (infiltration of skin by leukemic cells) appearing as nodules or plaques. Neurological findings such as cranial nerve palsies might be present if there is central nervous system involvement. Fever is common due to either the disease process itself or secondary infections from neutropenia. These physical findings vary depending on the type of leukemia (acute versus chronic) and the degree of bone marrow infiltration. The physical examination should be comprehensive as leukemia is a systemic disease that can affect multiple organ systems. Some patients may also present with symptoms such as fatigue, weight loss, malaise, and left upper quadrant fullness or pain due to splenomegaly 1. Rare manifestations include bleeding, thrombosis, gouty arthritis, retinal hemorrhages, and upper gastrointestinal ulceration 1. A thorough physical examination, including careful palpation of all lymph node areas, is essential for the initial evaluation of patients with suspected leukemia 1.
From the Research
Common Signs on Physical Exam of Leukemia
The common signs on physical exam of leukemia include:
- Hepatomegaly (enlargement of the liver) 2
- Splenomegaly (enlargement of the spleen) 2
- Pallor (pale skin) 2
- Fever 2
- Bruising 2
- Lymphadenopathy (enlargement of the lymph nodes) 3, 4, 5, 2
- Petechia (small red or purple spots on the skin) 6, 2
- Gingival enlargement and bleeding 6
- Oral ulceration 6
- Mucosal pallor 6
- Noma (a type of gangrenous stomatitis) 6
- Trismus (lockjaw) 6
- Oral infections 6
- Erythematopapular leukemic skin lesions 5
- Hepatosplenomegaly (enlargement of both the liver and spleen) 2
- Bleeding tendency 2
- Rash 2
- Recurrent infections 2
- Fatigue 2
- Limb pain 2
- Limp 2
- Joint pain 2
- Abdominal symptoms such as anorexia, weight loss, abdominal pain, and abdominal distension 2
- Musculoskeletal symptoms such as limp and joint pain 2
Specific Signs Associated with Certain Types of Leukemia
Certain types of leukemia may have specific signs on physical exam, such as: