The causes of acute leukemia are not yet fully elucidated, but there are specific groups of people who are more susceptible than the general population and therefore require special attention. For example:
1. Long-term exposure to radioactive substances
Ionizing radiation such as gamma rays and X-rays, such as survivors of atomic bombings, have a significantly higher incidence of leukemia within 5 years afterwards. Because the incidence is correlated with radiation dose, duration, and age, radiologists and nuclear power plant workers should have proper protection and limit the duration of exposure.
2. Chemical factors
For example:
- Paints, glues, hair dyes, etc. that contain high concentrations of benzene and formaldehyde;
- Anti-tumor drugs such as alkylating agents and anti-rejection drugs after organ transplantation are likely to cause secondary leukemia after one year of use;
- Ethylenedioxymorpholine, an ingredient in creams used to treat psoriasis, has been shown to be associated with the development of acute promyelocytic leukemia (APL);
- Smoking may be strongly associated with acute non-lymphocytic leukemia (ANLL).
3.
3. Viruses
For example, human T-lymphotropic virus-1 (HTLV-1), a type C retrovirus, can cause adult T-cell leukemia; it can be transmitted vertically from mother to child and laterally through blood product transfusion and sexual contact.
4. Genetic factors
Familial leukemia accounts for 7 per 1000 of leukemias, and the chance of identical twins having leukemia is 3 times higher than in other populations, and the incidence of leukemia is higher in congenital disorders such as Fanconi syndrome anemia, Downs syndrome, Bloom syndrome, and congenital immunoglobulin deficiency.
The onset of leukemia varies, with most progressing gradually over weeks to months and some starting rapidly. The first step in the process is to develop a new and better way of doing things. However, there are still many patients for whom no obvious cause or trigger can be found.
The clinical signs and symptoms of leukemia, mainly due to bone marrow failure or leukemic cell infiltration, are nonspecific, but often progressive, cannot be explained and treated with common benign diseases, and with a history of these diseases, are strongly recommended for disease screening at a hematologist.
1. Hemorrhage
More than half of patients with leukemia have bleeding as an early manifestation, which varies in severity and can be localized throughout the body. It mostly presents as spontaneous, or petechiae, petechiae, rhinorrhea, gingival bleeding and menorrhagia, and bleeding from the fundus of the eye that do not match the degree of trauma.
Hospital visits are needed for routine blood tests, local vascularity of the bleeding, and coagulation factor function to identify the cause of the bleeding.
2. Fever
Recurrent fever can also be an early manifestation in patients with leukemia, mostly around 38.5°C, without chills, with predominant afternoon fever, often accompanied by severe sweating throughout the night. Antibiotic use does not significantly affect the periodicity of the temperature, and it is best not to use antipyretics, such as Anacin and Benadryl, at this time, which can mask the original condition, but to actively improve blood work, infection-related indices, and and the valuable peripheral blood cell sorting test to observe the presence of protoinfantile hematopoietic cells to assess the possibility of leukemia.
Of course, some patients present with a high temperature, suggesting possible secondary infections such as gingivitis, stomatitis, pharyngitis, upper respiratory tract infection, pneumonia, enteritis, perianal infection, and severe infections such as sepsis, which are primarily associated with a significant reduction in mature granulocytes and should be synchronized with prompt, potent antibiotic therapy.
3. Anemia
Patients often have progressive pallor and atrophy, easy fatigue and drowsiness, and shortness of breath that is significantly worse after activities such as climbing stairs, which cannot be explained by poor diet or fatigue. It is recommended that routine blood tests be performed as soon as possible to clarify the extent and nature of anemia, which can be the first symptom of leukemia but is often not an early symptom, and half of patients have severe anemia at the time of presentation.
4. Painless enlargement of organs of unknown origin
Some patients with leukemia have enlargement of superficial lymph nodes, mostly in the submandibular, cervical, supraclavicular, axillary, and inguinal areas, often without significant pain; hepatosplenomegaly is found on physical examination in 50% of patients; painless enlargement of one testicle in young children or young adults in men is considered to be leukemic cell infiltration.
5. Skeletal and joint pain
There is often pressure pain in the lower sternum, a sign of massive leukemic cell infiltration. Infiltration of joints, periosteum, or overproliferation in the medulla can cause bone and joint pain, more common in children, more common and significant in acute gonorrhea than acute nongonorrhea, and severe skeletal pain in the presence of bone marrow necrosis.
6. Skin and mucosal lesions
Gingival hyperplasia or swelling, and atopic skin lesions manifesting as diffuse maculopapular rash, purple-blue skin nodules, or lumpy hard nodules should also be taken seriously. Leukemia can be associated with benign skin lesions such as Sweet syndrome (acute febrile neutrophilic dermatosis) and gangrenous pyoderma, in addition to subcutaneous infiltration of proto-naive cells, for which hormonal therapy is effective.
7. Central nervous system
If leukemia infiltrates brain cells and meninges, it can also cause neurologic symptoms such as headache, nausea, vomiting, hemiparesis, and loss of consciousness similar to cerebrovascular lesions, which can be identified by cranial CT and cerebrospinal fluid examination by lumbar puncture.
8. Green tumors
In 2% to 14% of acute nonlymphocytic leukemia, a large amount of myeloperoxidase in the leukemic cells turns green under dilute acid conditions and is called a green tumor, often involving bone, periosteum, soft tissue, lymph nodes, or skin, but most commonly in the orbit and paranasal sinuses. It may manifest as ocular protrusion, diplopia or blindness, which are characteristic manifestations of leukemia and require prompt diagnosis and treatment.
Once more than one of these symptoms occurs, prompt hospital examination is warranted:
- First of all, routine blood work is done. Most patients with leukemia have increased white blood cells, but there are also normal, or decreased, and most patients can have varying degrees of anemia and thrombocytopenia; and screening for infections and rheumatic diseases, etc.; peripheral blood smears can be read manually under the microscope for protoinfantile cells, strongly suggesting the possibility of leukemia;
- Leukemia is a lesion of the bone marrow and critically requires bone marrow aspiration and pathological sectioning, and to further confirm the type of leukemia, additional special tests are required, including.
- Special staining of bone marrow cells
- Flow cytometry examination
- Chromosome, prognosis-related gene and mutation gene examination
After analyzing the above data together and confirming the leukemia, the doctor will precisely classify and risk assess the patient and give the most appropriate treatment.