What are the symptoms of leukemia in children?

Symptoms of Leukemia in Children

The most common symptoms of leukemia in children include fatigue, weight loss, fever, and abdominal pain, which are observed in 46%, 25%, and 23% of patients at initial diagnosis, respectively. 1

Key Clinical Manifestations

Most Common Physical Findings (>50% of cases)

• Hepatomegaly (64%) 2
• Splenomegaly (61%) 2
• Pallor (54%) 2
• Fever (53%) 2
• Bruising (52%) 2

Common Symptoms (33-50% of cases)

• Recurrent infections (49%) 2
• Fatigue (46%) 2
• Limb pain (43%) 2
• Hepatosplenomegaly (42%) 2
• Bruising/petechiae (42%) 2
• Lymphadenopathy (41%) 2
• Bleeding tendency (38%) 2
• Rash (35%) 2

Bone Marrow Failure Manifestations

• Anemia: fatigue, pallor, dyspnea
• Thrombocytopenia: petechiae, bruising, bleeding
• Neutropenia: recurrent or persistent infections

Pain Symptoms

• Bone/joint pain (particularly in extremities)
• Abdominal pain (from organomegaly)

Type-Specific Presentations

Acute Lymphoblastic Leukemia (ALL)

• Most common in children
• Often presents with adenopathy, fever, bone pain and signs of anemia 3
• May have mediastinal mass (in T-ALL) 1
• Pain in extremities or joints may be the only presenting symptom 1

Chronic Myeloid Leukemia (CML)

• Characterized by high leukocyte counts and mild anemia with normal or elevated platelet counts 1
• Children with CML present with higher frequency of splenomegaly and larger spleen size compared to adults 1

Red Flags for Primary Care Physicians

• Multiple concurrent symptoms (fever + pallor + bruising)
• Persistent unexplained symptoms not responding to usual treatments
• Organomegaly (especially hepatosplenomegaly)
• Unexplained cytopenias on blood count
• Bone pain that wakes child at night or limits activity

Important Clinical Considerations

1. Early detection is critical: 95% of children with leukemia present with enlargement of lymph nodes, liver, and/or spleen at diagnosis 4

2. Asymptomatic presentation: Approximately 6% of children with leukemia are asymptomatic at diagnosis 2

3. Complications to watch for:

   • Leukostasis: priapism, respiratory or CNS abnormalities, visual disturbance, hearing loss 1
   • Bleeding: occurs in about 20% of children at diagnosis 1
   • Thrombosis: rare at diagnosis 1

4. Diagnostic approach: When leukemia is suspected, a complete blood count with differential and peripheral blood smear should be performed immediately

5. Referral: Any child with suspected leukemia should be promptly referred to a specialized cancer center with expertise in managing pediatric leukemia 1

Diagnostic Confirmation

The diagnosis of leukemia generally requires demonstration of ≥20% bone marrow lymphoblasts on hematopathology review of bone marrow aspirate and biopsy materials 1. In clinical situations with significant circulating disease (≥1,000 lymphoblasts/μL or ≥20% lymphoblasts), peripheral blood may substitute for bone marrow evaluation 1.

Remember that early recognition of these symptoms and prompt referral to a pediatric oncologist can significantly impact treatment outcomes and survival rates for children with leukemia.