Symptoms of leukemia

Typical cases of acute leukemia are characterized by a combination of anemic and intoxicating symptom-complex (pallor of the mucous membranes and skin with a gray-icteric shade, lethargy, weakness, subfebrile condition, etc.), proliferative (increased peripheral, mediastinal or abdominal lymph nodes, hepatosplenomegaly, , flat bones of the skull, etc.) and hemorrhagic syndromes. In addition, often at the first clinical detection of acute leukemia, there may be clinical and x-ray signs of damage to the bone system, the brain and its membranes (headaches, nausea, vomiting, impaired consciousness, lesions of the cranial nerves - often VI pairs, paraparesis , paralysis, seizures, etc.), testicles, leukemia infiltrates on the skin, etc. Many children have one or two characteristic for acute leukemia syndrome appear for 4-6 weeks or more before the development of the clinic, which allowed to make the correct diagnosis. DR Miller (1990) cites the characteristics of 4455 children with acute lymphoblastic leukemia:

• children up to a year - 3%, 1 - 10 years - 77%, over 10 years - 20%;
• boys - 57%, girls - 43%;
• fever - 61%; hemorrhage - 48%; pain in the bones - 23%; lymphadenopathy - 63% (expressed - 17%); splenomegaly - 57% (in 17% of the spleen was palpable below the navel), hepatomegaly - 61% (17% of the lower edge of the liver was below the navel), an increase in the mediastinal lymph nodes - 7%, CNS damage - 3%;
• anemia - 80% (in 20% hemoglobin is equal to or more than 100 g / l); thrombocytopenia with a platelet count below 20 thousand in μL - 28%, 20-100 thousand - 47%, equal to or more than 100 thousand - 25%; the number of leukocytes is less than 10 thousand in μL - 51%, 1 0 - 5 0 thousand in μL - 30%, more than 50 thousand in μL - 19%;
• morphology of lymphoblasts: L1 - 85%; L2 - 14%, L3 - 10%.

With ONL less frequent than with acute lymphoblastic leukemia, proliferative, but more frequent intoxication, anemic and hemorrhagic syndromes, lesions of the central nervous system, bones, gingival hypertrophy, hyperleukocytosis.

Leukostasis syndrome develops in patients with acute leukemia with a high level of leukocytes in peripheral blood (more than 100,000 in μl) and is the result of aggregation of blasts in capillaries. Most often it begins with cardiorespiratory disorders with the development of acute respiratory failure and pulmonary edema or with a picture of pneumonia, less often with CNS phenomena with a sharp headache or stroke-like condition.

Infections - a regular complication of the course of acute leukemia as a consequence of the development of primary and secondary immunodeficiency syndrome (a consequence of cytostatic therapy, granulocytopenia). Especially dangerous is neutropenia with a neutrophil count of less than 500 in μl. It is believed that with such an expression of neutropenia in the third week, the percentage of infectious complications is close to 100%. Therefore, any fever in children with such severe neutropenia is an indication for active anti-infective therapy (cephalosporins III and IV generations, meronem, imipinem, tazocine, etc.). Against the backdrop of complex cytostatic therapy, whole blood transfusions are dangerous in terms of infecting not only with hepatitis B, C, E viruses, but also with herpes viruses, Candida mushrooms, and others.

In the stage of complete clinical remission, there are no clinical manifestations of acute leukemia, ie, deviations from the norm when examining the child: the percentage of blast cells in the myelogram does not exceed 5%, and the number of lymphocytes in the myelogram is less than 20%; in the peripheral blood blast cells should not be, but moderate thrombocytopenia and leukopenia are possible due to the cytostatic effect of therapy; in the cerebrospinal fluid there is no deviation from the norm.

Recurrence of acute leukemia can occur in the bone marrow (detection in the myelogram of more than 5% of blast cells) and extraosternal ("extramedullary") with different localization of leukemia infiltration (neuroleukemia, leukemia infiltration of testicles, spleen, lymph nodes, maxillary sinuses, etc.).

[1], [2], [3], [4], [5]