Symptoms and Diagnosis

What are the Symptoms of Leukemia?

Because leukemia is cancer of the blood-forming tissue called the bone marrow, the initial symptoms are often related to irregular bone marrow function. The bone marrow is responsible for storing and producing about 95 percent of the body's blood cells, including the red blood cells, white blood cells, and platelets.

When leukemia occurs, the abnormal white blood cells (blasts) begin to reproduce very rapidly and begin crowding out and competing for nutrients and space with the other healthy cells. The following are the most common symptoms of leukemia. However, each child may experience symptoms differently.

Symptoms may include:

• Anemia: When red blood cells are unable to be produced because of the crowding in the marrow, anemia is present. With anemia, the child may appear tired, pale, and may breathe faster to compensate for the decrease in oxygen carrying capacity. The number of red blood cells on a blood count will be below normal.
• Bleeding and/or bruising: When platelets are unable to be produced because of the crowding in the marrow, bleeding can occur and the child may begin to bruise more easily. Petechia are tiny red dots often seen on the skin of a child with low number of platelets. Petechia are very small blood vessels that have "leaked" or bled. The number of platelets on a blood count will be below normal. Thrombocytopenia is the term used for a decreased number of platelets.
• Recurrent infections: Although there may be an unusually high number of white blood cells on a blood count of a child with leukemia, these white blood cells are immature and do not fight infection. The child may have had repetitive viral or bacterial infections over the past few weeks. The child with leukemia often shows symptoms of an infection such as fever, runny nose, and cough.
• Bone and joint pain: Pain in bones and joints is another common symptom of leukemia. This pain is usually a result of the bone marrow being overcrowded and "full."
• Abdominal distress: Abdominal pain may also be a symptom of leukemia. Leukemia cells can collect in the kidney, liver, and spleen, causing enlargement of these organs. Pain in the abdomen may cause a child to have loss of appetite and weight loss.
• Swollen lymph nodes: The child may also have swelling in the lymph nodes under the arms, in the groin, chest, and in the neck. Lymph nodes are responsible for filtering the blood. Leukemia cells may collect in the nodes, causing swelling.
• Difficulty breathing (dyspnea): With T-cell ALL, these leukemia cells tend to clump together around the thymus. This mass of cells present in the middle of the chest can cause pain and difficulty breathing (dyspnea). Wheezing, coughing, and/or painful breathing requires immediate medical attention.

With acute leukemia (ALL or AML), these symptoms may occur suddenly in a matter of days or weeks. With chronic leukemia (CML), these symptoms may develop slowly over months to years.

It is important to understand that the symptoms of leukemia may resemble other blood disorders or medical problems. These are common symptoms of the disease, but do not include all possible symptoms. Children may experience symptoms differently. Always consult your child's physician for a diagnosis.

How is Leukemia Diagnosed? 

In addition to a complete medical history and physical examination, diagnostic procedures for leukemia may include:

• Bone Marrow Aspiration and/or Biopsy
• Complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.
• Additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies.
• Computed Tomography Scan (CT or CAT scan)
• Magnetic Resonance Imaging (MRI)
• X-Ray
• Ultrasound
• Lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a microscope.
• Lumbar Puncture (Spinal Tap)