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

Symptoms of Acute Myeloid Leukemia (AML)

The most common symptoms of AML are fatigue, bleeding/bruising, and fever/infections, which result directly from bone marrow failure causing anemia, thrombocytopenia, and neutropenia. 1, 2

Primary Presenting Symptoms

The clinical presentation of AML reflects the underlying cytopenias that develop as malignant blasts replace normal bone marrow:

Fatigue and Weakness

• Fatigue is one of the three cardinal symptoms of AML and results from anemia due to decreased red blood cell production 1, 2
• Patients may also experience shortness of breath and dizziness related to anemia 1
• Severe fatigue reported before treatment has independent prognostic value and associates with decreased survival, making this symptom particularly important to assess 1, 2

Bleeding Manifestations

• Easy bleeding or bruising is common, resulting from thrombocytopenia and/or platelet dysfunction 1, 2
• Physical examination may reveal petechiae, purpura, or ecchymoses 2
• Coagulopathy is common at presentation in many leukemias, particularly in acute promyelocytic leukemia (APL), which can lead to life-threatening bleeding complications 3, 2

Fever and Infections

• Fever and recurrent infections occur due to neutropenia and leukocyte dysfunction 1, 2
• These infectious complications are particularly problematic in patients aged ≥60-65 years, who are more susceptible to severe infections 2

Constitutional Symptoms

Beyond the primary triad, patients frequently present with additional systemic symptoms:

• Constitutional symptoms include fever, night sweats, and weight loss 1
• These symptoms are common enough that their presence should prompt immediate evaluation for AML 1

Physical Examination Findings

Common Findings

• Pallor from anemia 2
• Petechiae, purpura, or ecchymoses from thrombocytopenia 2

Less Frequent Findings

• Approximately 20% of AML patients present with lymphadenopathy 1, 2
• Splenomegaly and hepatomegaly are less common physical findings 1

Emergency Presentations Requiring Immediate Recognition

Leukostasis

• Patients with excessive leukocytosis (WBC count >40,000/mcL) should be evaluated urgently for leukostasis, which represents a medical emergency 3, 2
• This is particularly important in patients with monocytic differentiation 3

Coagulopathy

• Screening for coagulopathy by evaluating prothrombin time, partial thromboplastin time, and fibrinogen activity should be performed as part of initial evaluation and before any invasive procedure 3
• This is especially critical in APL, where coagulopathy can be life-threatening 2

Clinical Pitfalls and Key Considerations

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 The combination of fatigue, bleeding, fever, and constitutional symptoms should trigger urgent hematologic evaluation, as delays in diagnosis can lead to life-threatening complications from infection, bleeding, or leukostasis. 1, 2