Acute lymphoblastic leukemia most commonly affects children below 15 years of age. It is rare among adults. The symptoms are usually slow in onset but may rapidly get severe as the number of immature white blood cells (blast cells) rises and overcrowd other cells in the blood.

The symptoms of ALL are indicative of the underlying pathology of the cancer. The symptoms of ALL include:-

• Pallor – the skin and mucus membranes are 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 ALL patients.
• There may be breathlessness, palpitations and easy fatigability due to anemia and inadequate oxygenation.
• As the blast cells rise in the blood, the adult and mature functioning white blood cells decline in number. This causes lowering of immunity and raises the risk of repeated infections. 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. Common infections include those in the mouth, throat, skin and groin.
• Due to lowering of platelet counts in the blood there is an increased risk of bleeding. 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.
• 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.
• 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.
• There may be loss of appetite and weight loss.
• 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.