What are the symptoms of Acute Myeloid Leukemia (AML)?

Symptoms of Acute Myeloid Leukemia (AML)

AML most commonly presents with fatigue, bleeding manifestations, and fever/infections resulting from bone marrow failure, with these symptoms reflecting the underlying cytopenias (anemia, thrombocytopenia, and neutropenia). 1

Primary Presenting Symptoms

Symptoms from Bone Marrow Failure

The clinical presentation of AML directly reflects the replacement of normal hematopoiesis by leukemic cells:

• Fatigue and lethargy are among the most common presenting complaints, resulting from anemia secondary to bone marrow failure 1
• Easy bleeding or bruising occurs due to thrombocytopenia and/or platelet dysfunction 1
• Fever and recurrent infections develop from neutropenia and leukocyte dysfunction 1

Importantly, severe fatigue reported before treatment has independent prognostic value and associates with decreased survival, making careful evaluation of this symptom particularly critical. 1

Constitutional Symptoms

Beyond the direct effects of cytopenias, patients frequently experience systemic manifestations:

• Night sweats are commonly reported 1
• Unintentional weight loss occurs frequently 1
• Shortness of breath and dizziness relate directly to anemia 1

Physical Examination Findings

Common Findings

Physical examination may reveal signs related to the underlying cytopenias and leukemic infiltration:

• Pallor from anemia 1
• Petechiae, purpura, or ecchymoses from thrombocytopenia 1

Less Frequent Findings

Organomegaly and lymphadenopathy are less common but important to assess:

• Lymphadenopathy occurs in approximately 20% of AML patients 1
• Splenomegaly and hepatomegaly are less common physical findings 1

Emergency Presentations

Leukostasis

Patients with excessive leukocytosis at presentation may develop clinical signs of leukostasis, which represents a medical emergency requiring urgent intervention 2

Coagulopathy

Leukaemia-related coagulopathy must be detected early, particularly in acute promyelocytic leukemia (APL), as this can lead to life-threatening bleeding complications 2

Clinical Pitfalls and Caveats

The presentation of AML can be insidious, and symptoms may be attributed to other common conditions initially. The key is recognizing the constellation of symptoms—particularly when fatigue, bleeding, and infections occur together—which should prompt urgent hematologic evaluation. 1

Patients aged ≥60-65 years are more susceptible to treatment complications, particularly severe infections, which contributes to higher risk of unfavorable outcomes. 2 Pre-existing medical conditions such as diabetes, coronary heart disease, or chronic obstructive pulmonary disease must be recognized as contributing to poor risk. 2

Any patient presenting with unexplained cytopenias, particularly when accompanied by constitutional symptoms, requires immediate complete blood count with differential and peripheral blood smear examination to evaluate for circulating blasts. 2, 1