Symptoms of acute lymphoblastic leukemia

The main symptoms of acute lymphoblastic leukemia are weakness, fever, malaise, pain in the bones and/or joints, hemorrhagic syndrome (bleeding of the oral mucosa, skin hemorrhages), and pallor. Fever is usually associated with bacterial, viral, fungal or protozoal (less common) infection, especially in children with severe neutropenia (less than 500 neutrophils per μl). Weakness occurs as a result of anemia and intoxication.

Hemorrhagic syndrome is associated with both thrombocytopenia and intravascular thrombosis (especially with hyperleukocytosis). It leads to the appearance of petechiae and ecchymoses. melaena, vomiting with blood. Gastrointestinal bleeding is usually caused by thrombocytopenia, coagulopathy, or toxic effects of chemotherapeutic drugs on the mucous membrane.

Leukemic infiltration of the periosteum and joint capsule, bone infarctions and tumoral enlargement of the bone marrow lead to pain. Radiographic examination reveals characteristic changes, especially in tubular bones, near large joints. Pain may also occur later, as a result of osteoporosis or aseptic necrosis. Pathological fractures, including spinal fractures, may occur during long-term treatment with prednisolone and methotrexate. Joint pain and swelling may be mistaken for symptoms of rheumatoid arthritis or other diseases.

The spread of blasts to the lymph nodes and parenchymatous organs leads to lymphadenopathy, enlargement of the liver and spleen. Clinically, organ damage is manifested by abdominal pain, widening of the mediastinum with the development of compression syndrome, and enlargement of the testicles in boys. Initial enlargement of the testicles in the form of painless dense unilateral or bilateral infiltrates is noted in 5-30% of cases of primary acute lymphoblastic leukemia. The true frequency of ovarian damage is unknown; according to some studies, it ranges from 17 to 35%. The ovaries are especially often affected in hyperleukocytosis and the T-cell variant of acute lymphoblastic leukemia.

There are known cases of significant kidney enlargement as a result of leukemic infiltration, although clinical symptoms may be absent. During treatment, the kidneys may enlarge due to an increase in the concentration of uric acid and other purine metabolic products in the blood plasma, which clog the renal tubules.

Rare complications include myocardial infiltration and pericardial effusion due to obstruction of lymphatic drainage pathways between the endocardium and epicardium. Cardiomyopathy may develop later as a result of infectious complications and the use of cardiotoxic anthracycline antibiotics.

Respiratory system disorders may be associated with enlarged mediastinal lymph nodes or enlarged thymus (typical of T-cell leukemia), leukemic infiltration of lung tissue or hemorrhages into it. Sometimes it is difficult to differentiate these complications from an infectious process.

The most common signs of eye damage in acute lymphoblastic leukemia are retinal hemorrhages, vascular infiltration and optic nerve papilla edema, which occur as a result of neuroleukemia, thrombocytopenia, and coagulopathy.

Manifestations of neuroleukemia may include damage to the cranial nerves, general cerebral and meningeal symptoms.

Leukemids may appear - cyanotic dense painless infiltrative elements on the skin. Any damage to the skin becomes an entry point for infection, so paronychia, panaritium, cellulitis or infected insect bites and injection marks are often found.

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