Introduction

  • At first, the symptoms of ALL can be not very specific and difficult to recognise. Sometimes, ALL is observed during a routine blood test.
  • Without treatment, ALL usually progresses quickly and most patients have symptoms when they are diagnosed.
  • Presentation at Accident and Emergency departments occurs in 66% of patients with ALL.
  • Patients with ALL produce too many leukaemia cells which overwhelms the bone marrow (Figure¬†4). This prevents it producing red blood cells, platelets and white blood cells.

Figure 4        Bone marrow congested with abnormal leukaemia cells

More generally, reduced levels of blood cells being produced by the bone marrow leads to some of the main symptoms of ALL:

  • Low levels of red cells lead to a decrease in distribution of oxygen to the body tissues causing anaemia
  • Low levels of white blood cells prevent patients fighting infections
  • Low levels of platelets make patients prone to a greater risk of bleeding
  • The most common ALL signs and symptoms of ALL are:
  • Weakness or fatigue
  • Pale skin
  • Fever and/or night sweats
  • Unexpected weight loss or anorexia
  • Difficulty breathing
  • Easy bruising, bleeding gums, purpura or petechiae, (Figure 5)
  • Purpura look similar to bruises, but they are not due to injury. They tend to be seen in clusters over a single area of the body.
  • Petechiae: 2 mm, flat, red/purple spots that, like purpura, are non‚ÄĎblanching when pressed beneath a glass.
  • Frequent chest or urinary tract infections
  • Unexplained painless swollen lymph nodes in the neck, armpit, or groin
  • Swelling/discomfort in the abdomen due to enlarged spleen or liver
  • Pain in the bones or joints
  • If the leukaemia cells penetrate the CNS and cerebrospinal fluid (CSF) the following neurological symptoms may occur:
  • Headaches and dizziness
  • Blurred vision
  • Seizures
  • Vomiting

Figure 5         Skin signs of ALL


Petechiae on lower leg

Purpura on the arm