By Dr Ananya Mandal, MD
The symptoms of Acute myeloid leukemia are usually slow in onset but may rapidly become severe as the number of immature white blood cells (blast cells) rises and overcrowds other cells in the blood.
The symptoms of AML are indicative of the underlying pathology of the cancer. The symptoms of AML include:-
Generalized symptoms of AML include:
loss of appetite
Unexplained and long term fever may be one of the symptoms. Fever is usually over 38C (100.4F). Fever is usually accompanied by excessive sweating and night sweats.
The skin and mucus membranes are pale. Mucous membranes within the mouth and the conjunctiva are usually seen to be pale. This is the hallmark sign of anemia.
Due to the rise in number of blast cells in blood the red blood cells are lowered in number and this may result in anemia. Tiredness and fatigue are symptoms that are associated with anemia and are seen commonly in AML patients. Patient may feel cold, dizzy and lightheaded.
Due to anemia many patients may also develop headaches and weakness. There may be breathlessness, palpitations and easy fatigability due to anemia and inadequate oxygenation.
As the blast cells rises in blood the adult and mature functioning white blood cells decline in number. This is called leukopenia. This causes lowering of immunity and raises the risk of repeated infections.
The patient may present with repeated episodes of infections. Some of them may be simple infections that take longer to go away and sometimes with more severe immunity-depression there may be life threatening infections.
Risk of bleeding
Due to lowering of platelet counts in blood there is an increased risk of bleeding. This is called thrombocytopenia. There may be nose bleeds, heavy menstrual bleeding or bleeding from the gums.
Platelets normally help in clotting and prevent bleeding. Low platelet counts result from rising number of blast cells in blood. There may be bruises caused by minor injuries and severe and uncontrolled bleeding caused by injuries.
Bleeding may occur within the joints, in the brain etc. creating life threatening complications. There may be bone and joint pain due to bleeding.
With thrombocytopenia and abnormal bleeding there may also be another problem of increased blood clotting or embolism or thrombosis. There may be a life threatening complication called deep venous thrombosis (DVT) or pulmonary embolism (PE) as a result.
Swollen lymph nodes are another common symptom that may be seen.
Liver and spleen may be enlarged and may be felt on palpating the abdomen.
If the cancer affects the central nervous system there may be neurological symptoms including headaches, seizures or fits, blurring of vision, stiffness of the neck, irritability and dizziness. Some patients may experience nausea and vomiting as well.
The blast cells or immature white blood cells are bigger than normal white blood cells and thus have more difficulty going through tiny blood vessels. In advanced cases, with very high blast cell counts, these cells clog up blood vessels and do not allow red blood cells to reach the peripheral organs and limbs. This is called leukostasis.
This may lead to stroke like symptoms like headache, weakness of one side of the body, confusion, dizziness, sleepiness and slurred speech. When blood vessels in the lung are affected, there may be wheezing and breathlessness.
If eye blood vessels are affected blurry vision or even loss of vision can occur. Leukostasis is rare but is a medical emergency that needs to be treated urgently.
Lumps or spots or rashes
Leukemia cells especially in AML can spread to the skin. They appear as lumps or spots or rashes. A tumor-like collection of AML cells under the skin is termed chloroma or granulocytic sarcoma. AML cells may also spread to the gums causing swelling, pain, and bleeding.
Spread to other organs
Very rarely AML can spread to other organs like kidneys, testes etc.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)