Acute leukemia often starts with high fever, bleeding, or bone pain, and may also manifest as malaise or weight loss. Chronic leukemia has a slow onset and symptoms may not be apparent in the early stages until late in life.
Fever and infection
The sites of infection are diverse, with open areas such as the mouth, gums, nasopharynx, lungs, gastrointestinal tract, anus, and urinary tract predominating, and may progress rapidly to bacteremia or sepsis. Leukopenia, abnormal neutrophil function, reduced skin mucosal barrier function, dysbiosis due to long-term use of broad-spectrum antibiotics, low autoimmune function, and application of immunosuppressive drugs to increase opportunistic infections are the main causes of infection.
Hemorrhage
The main manifestations are bleeding from the skin and mucous membranes, such as bleeding spots on the skin, petechiae, nasal bleeding, blood oozing from the gums, and blood blisters in the mouth; bleeding from the gastrointestinal tract, respiratory tract, urinary tract, fundus, and even the central nervous system can also be seen and can be life-threatening in severe cases. Thrombocytopenia and abnormal function, coagulation abnormalities and leukemic cell infiltration of the vessel wall are the main causes of bleeding.
Anemia
Manifestations include pallor, dizziness, fatigue, tinnitus, palpitations, chest tightness, dyspepsia, and polyuria, with bilateral lower limb edema seen in severe cases. The main cause of anemia is inhibition of bone marrow red blood cell hematopoiesis due to leukemic cell infiltration and chemotherapy. Anemia can also be exacerbated by blood loss, hemolysis, lack of hematopoietic material, and decreased EPO production.
Hepatomegaly, splenomegaly, lymph nodes, and thymus gland
Hepatosplenomegaly is seen in more than 70% of acute lymphoblastic leukemia (ALL) and more than 50% of acute myeloid leukemia (AML). lymph node and thymus enlargement is common in ALL, and thymus enlargement is seen in 7%-10% of children and 15% of adults, and can cause superior vena cava obstruction syndrome; whereas lymph node enlargement is rare in AML, and thymic leukemic cell infiltration does not usually occur. .
Skin damage
About 10% of AML may present with limited or diffuse purple raised skin nodules or plaques with leukemic cell infiltration on pathologic examination; whereas only 1% of ALL has skin infiltration. Nonspecific skin lesions such as petechiae, urticaria, pruritus, and erythema multiforme are also seen.
Bone and joint pain
Physical examination in acute leukemia often reveals sternal pressure pain. Bone and joint pain is associated with increased pressure in the bone marrow cavity due to massive proliferation of leukemic cells and leukemic erosion of the bone parenchyma, periosteum, and joint cavity.
Central nervous system leukemia (CNSL)
CNSL is a serious complication of acute leukemia. The infiltration site is mostly in the arachnoid and dura mater, followed by the brain parenchyma, choroid, or cranial nerves. In severe cases, there are typical manifestations of increased intracranial pressure such as headache, vomiting, optic papilloedema, and even convulsions and coma, while in mild cases, there is only mild headache and dizziness.
In addition, chronic granulocytic leukemia has a slow onset and often has no conscious symptoms in the early stages, and is most often seen as a result of abnormal blood picture or splenomegaly during health checkups or when seeking medical attention for other diseases. As the disease progresses, weakness, low-grade fever, excessive sweating or night sweats, and weight loss may appear. As a result of splenomegaly, symptoms such as left upper abdominal cramping and fullness after eating are felt.