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 mucous membranes of the oral cavity, cutaneous hemorrhages), pallor. Fever is usually associated with a 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. Melena, vomiting with blood. Bleeding from the gastrointestinal tract is usually caused by thrombocytopenia, coagulopathy, or toxic effects of chemotherapeutic drugs on the mucous membrane.

Leukemia infiltration of the periosteum and articular capsule, bone marrow infarction and tumor increase in bone marrow volume lead to the appearance of pain. X-ray reveals characteristic changes, especially in tubular bones, near large joints. Pain can also occur later, as a result of osteoporosis or aseptic necrosis. In the course of long-term treatment with prednisolone and methotrexate, pathological fractures can occur, including vertebral fractures. Pain and swelling of the joints can be taken for the symptoms of rheumatoid arthritis or other diseases.

The spread of blasts to the lymph nodes and parenchymal organs leads to lymphadenopathy, enlargement of the liver and spleen. Clinically, organ lesions are manifested by pain in the abdomen, an expansion of the mediastinum with the development of the compression syndrome, an increase in the testes in boys. An initial increase in testicles in the form of painless dense one- or bilateral infiltrates was noted in 5-30% of cases of primary acute lymphoblastic leukemia. The true incidence of ovarian failure is unknown, according to some studies, it ranges from 17 to 35%. Ovaries are especially often affected by hyperleukocytosis and T-cell variant of acute lymphoblastic leukemia.

There are cases of significant increase in kidneys as a result of leukemia infiltration, with clinical symptoms may be absent. In the process of treatment, the kidneys can increase due to an increase in the blood plasma concentrations of uric acid and other products of metabolism of purines clogging the renal tubules.

Rare complications - infiltration of the myocardium and exudate pericarditis due to obstruction of the lymphatic drainage pathways between the endocardium and the epicardium. Cardiomyopathy can develop later as a result of infectious complications and the use of cardiotoxic anthracycline antibiotics.

Disturbances from the respiratory system may be associated with an increase in the mediastinal lymph nodes or with an increase in thymus (typical of T-cell leukemia), with leukemia infiltration of the lung tissue or hemorrhage into it. Sometimes it is difficult to differentiate these complications with the infectious process.

The most common signs of eye damage in acute lymphoblastic leukemia are hemorrhages in the retina, infiltration of vessels and edema of the nipple of the optic nerve, resulting from neiroleukemia, thrombocytopenia, coagulopathy.

Manifestations of neuroleukemia can be lesions of the cranial nerves, cerebral and meningeal symptoms.

Perhaps the emergence of leukemids - cyanotic dense, painless infiltrative elements on the skin. Any damage to the skin becomes an input gateway for infection, so often paronychia, panaritium, cellulite or infected insect bites and traces of injections.

[1], [2], [3], [4], [5], [6], [7], [8]