Common Signs and Symptoms of Leukemia
The most common signs and symptoms of leukemia include fatigue, pallor, fever, easy bruising/bleeding, splenomegaly, hepatomegaly, and recurrent infections, with specific presentations varying by leukemia type and patient age. 1, 2
Key Clinical Manifestations by Frequency
Very Common Signs (>50% of patients)
- Hepatomegaly (64%)
- Splenomegaly (61%)
- Pallor (54%)
- Fever (53%)
- Bruising (52%)
Common Signs (33-50% of patients)
- Recurrent infections (49%)
- Fatigue (46%)
- Limb/bone/joint pain (43%)
- Hepatosplenomegaly (42%)
- Bruising/petechiae (42%)
- Lymphadenopathy (41%)
- Bleeding tendency (38%)
- Rash (35%)
Other Important Manifestations
- Constitutional symptoms (weight loss, night sweats)
- Abdominal pain or fullness
- Dyspnea
- Dizziness
- Anorexia
Presentation Differences by Leukemia Type
Chronic Myeloid Leukemia (CML)
- Often presents with fatigue, weight loss, malaise
- Left upper quadrant fullness/pain from splenomegaly
- Possible rare manifestations:
- Bleeding (with low platelets/platelet dysfunction)
- Thrombosis (with thrombocytosis/marked leukocytosis)
- Gouty arthritis (elevated uric acid)
- Retinal hemorrhages
- Upper GI ulceration (from basophilia)
- Splenomegaly is the most consistent physical sign (40-50% of cases) 1
Acute Lymphoblastic Leukemia (ALL)
- More common in children
- Fatigue, constitutional symptoms
- Pain in extremities/joints (may be the only symptom in children)
- Lymphadenopathy, splenomegaly, hepatomegaly (20% of patients)
- Abdominal masses (more common in mature B-cell ALL)
- Chin numbness or facial palsy (cranial nerve involvement) 1
Hairy Cell Leukemia (HCL)
- Fatigue and weakness
- Splenomegaly (symptomatic or asymptomatic)
- Hepatomegaly
- Pancytopenia
- Recurrent opportunistic infections
- Uncommon peripheral lymphadenopathy 1
Chronic Lymphocytic Leukemia (CLL)
- Affects older individuals, more common in men (2:1 ratio)
- Fatigue, reduced exercise tolerance
- Enlarged lymph nodes
- Splenomegaly
- Advanced disease: fever, weight loss, anemia, bleeding, infections 3
Age-Related Differences
Children
- Pain in extremities or joints may be the only presenting symptom
- Higher incidence of ALL compared to adults
- May present with chin numbness from cranial nerve involvement 1
Adults
- Higher incidence of CML, CLL, and AML compared to children
- More likely to present with constitutional symptoms 4
Laboratory Abnormalities
- Complete blood count (CBC) abnormalities:
- Leukocytosis (elevated white blood cell count)
- Anemia (low hemoglobin)
- Thrombocytopenia (low platelets) or thrombocytosis (elevated platelets)
- Abnormal cells on peripheral blood smear 5
Important Considerations
- Approximately 6% of children with leukemia may be asymptomatic at diagnosis 2
- Symptoms are often nonspecific and may mimic common childhood illnesses
- The presence of multiple symptoms and signs should raise suspicion for leukemia
- Thorough physical examination should include abdominal palpation for hepatosplenomegaly, assessment for lymphadenopathy, and careful skin examination 2
- Prompt referral to a hematologist-oncologist is essential when leukemia is suspected 4
Warning Signs Requiring Immediate Attention
- Severe bleeding
- Signs of infection with neutropenia
- Symptoms of leukostasis (priapism, dyspnea, drowsiness, confusion) - uncommon in chronic phase despite high WBC counts 1
- Symptoms of tumor lysis syndrome (acute kidney injury, electrolyte abnormalities)
Early recognition of these signs and symptoms is crucial for timely diagnosis and treatment, which significantly impacts morbidity, mortality, and quality of life outcomes for patients with leukemia.