Early Signs and Symptoms of Leukemia: What You Need to Know

Acute leukemia in children and adolescents often develops rapidly, with common initial symptoms including fever, progressive anemia, severe bleeding tendencies, or bone and joint pain. In contrast, cases with a slower onset are more frequently seen in older adults and some younger individuals, where the disease progresses gradually over time. A small number of patients may even present with unusual early signs such as seizures, vision loss, toothache, swollen gums, pericardial effusion, or paralysis of the lower limbs—symptoms that might delay accurate diagnosis if not properly evaluated.

Common Symptoms of Leukemia

Fever: One of the Most Frequent Early Indicators

Fever is among the most prevalent symptoms of leukemia and can vary widely in intensity and pattern. The primary cause of fever in these patients is infection, often stemming from conditions like pharyngitis, oral mucositis, or infections around the anal region. Other frequent sources include pneumonia, tonsillitis, gingivitis, and perianal abscesses. However, it's important to note that fever can also result directly from the leukemia itself—a phenomenon known as "tumor fever"—even in the absence of detectable infection.

Infections: Increased Vulnerability Due to Weakened Immunity

Infections are a major concern for leukemia patients, primarily due to a significant drop in healthy white blood cells, especially neutrophils. Bacterial infections are the most common early on, but as the disease advances and patients undergo prolonged treatment with broad-spectrum antibiotics, the risk of fungal infections—such as candidiasis or aspergillosis—rises substantially. This shift underscores the importance of vigilant monitoring and tailored antimicrobial strategies during treatment.

Bleeding and Bruising: A Sign of Platelet Dysfunction

Bleeding complications can occur throughout the body and are often linked to low platelet counts (thrombocytopenia). The most commonly affected areas include the skin (manifesting as petechiae or easy bruising), gums, and nasal passages. More serious and potentially life-threatening hemorrhages may involve the retina, inner ear, gastrointestinal tract, or lungs. In severe cases, intracranial bleeding can occur, requiring immediate medical intervention.

Other Key Clinical Manifestations

Anemia: Often Present at Early Stages

Anemia is typically one of the first noticeable signs, leading to fatigue, weakness, pale skin, and shortness of breath. It results from the bone marrow's reduced ability to produce healthy red blood cells due to the overcrowding of leukemic blasts. In some rare instances, patients may have had undiagnosed myelodysplastic syndromes (MDS) months or even years before progressing to full-blown leukemia, highlighting the need for long-term hematological follow-up in high-risk individuals.

Bone and Joint Pain: Caused by Marrow Expansion

Pain in the bones or joints is another hallmark symptom, particularly in pediatric cases. This discomfort arises when rapidly dividing leukemia cells accumulate in the bone marrow, increasing internal pressure and irritating nerve endings. The long bones of the legs and arms, as well as the spine, are frequently affected.

Enlarged Organs: Hepatomegaly, Splenomegaly, and Lymphadenopathy

Many patients also experience enlargement of the liver (hepatomegaly), spleen (splenomegaly), or lymph nodes (lymphadenopathy). These occur as leukemia cells infiltrate these organs, disrupting normal function and sometimes causing abdominal discomfort or a feeling of fullness.

It's crucial to remember that while these symptoms may suggest leukemia, they are not definitive on their own. Many overlap with other, less serious conditions. Therefore, proper diagnosis through blood tests, bone marrow biopsy, and imaging studies is essential. Always consult a qualified healthcare provider for evaluation, diagnosis, and personalized treatment planning.