Clinical Features

• Sudden onset of symptoms and rapid progression (days to weeks)

• Anemia: fatigue, pallor, weakness

• Thrombocytopenia: epistaxis, bleeding gums, petechiae, purpura

• Immature leukocytes: frequent infections, fever

• Hepatosplenomegaly (caused by leukemic infiltration)

• Oncologic emergencies can be the first sign of leukemia, e.g., an elderly patient presenting with priapism or DIC may have leukostasis (more common in AML than ALL)

• Fever, night sweats, unexplained weight loss

• Painless lymphadenopathy

• Bone pain (presenting as limping or refusal to bear weight in children)

• Airway obstruction (stridor, difficulty breathing) due to mediastinal or thymic infiltration (primarily in T-cell ALL)

• Features of SVC syndrome

• Meningeal leukemia (or leukemic meningitis) → headache, neck stiffness, visual field changes, or other CNS symptoms (caused by CNS involvement)

• Testicular enlargement (rare finding)

• Leukemia cutis (or myeloid sarcoma): nodular skin lesions with a purple or gray-blue color

• Gingival hyperplasia (AML subtype M4 and M5)

• Signs of CNS involvement, e.g., headache, visual field changes (uncommon)

Fever and lymphadenopathy are rare in AML, but can be common first signs in ALL!

Fever in a patient with acute leukemia must always be treated as a sign of infection until proven otherwise!

Remember metastasis for ALL by thinking of the following: ALL metaStaSizeS to the CNS and teSteS.

Leukemia cutis