Clinical Manifestations and Pathology

Some of the first symptoms of acute leukemia are similar to those of common infectious illness. All the leukemias share common signs and symptoms arising from the infiltration of the bone marrow, with leukemic cells replacing the normal tissues. The lack of red cells causes fatigue and anemia, the lack of normal white cells results in infections and fever, and the lack of platelets produces bleeding and bruising. The lymph nodes, spleen, and liver may become enlarged as they are infiltrated with leukemic cells. Bone or joint pains are associated symptoms, and purpura is often present. Although the basic features of the leukemias are common, marked differences exist between the acute and chronic leukemias in their mode of presentation. In the acute leukemias, influenza-type symptoms and fever (present for only days or weeks) signal the sudden and rapid progress of the acute form of the disease. Weakness, exhaustion, enlargement of the lymph nodes, abnormal bleeding (from the gums for example), and a tendency to bruise easily are some of the chief symptoms.

By contrast, the symptoms of chronic leukemias are generally far more subtle. It is not uncommon for the disease to be discovered accidentally when a blood test is carried out for an unrelated reason. The most common symptoms are loss of energy, tiredness, fever, night sweats, and loss of appetite. There may also be enlargement of the liver and spleen and the lymph nodes.

Leukemia can be diagnosed only by microscopic examination of the blood and the bone marrow. A blood test may show low hemoglobin, low levels of normal white cells, and a low platelet count; and leukemic blast cells may be present. A bone marrow biopsy will confirm the diagnosis of leukemia and the predominant cell type involved, which will enable the leukemia to be correctly classified.

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