- 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‑blanching 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 |
