Each of the four major types of leukemias have different presentation, signs and symptoms.

Symptoms of acute myeloid leukaemia (AML)

These may begin slowly and progress to severity rapidly. The basic pathology is uncontrolled growth of the blast cells or immature bone marrow cells within the bone marrow. Most of the symptoms are caused by the lack of healthy blood cells in the blood circulation and presence of immature blast cells.

Symptoms include:-

• Anemia manifested by tiredness, weakness, fatigue, breathlessness, pale skin conjunctiva and nail beds.
• Having repeated infections over a short space of time.
• Bleeding that is frequent and brought about by minor trauma. Commonly seen are bleeding gums or nose bleeds. Similarly there may be excessive bruising even on minor trauma.
• Fever that is unexplained and lasts for long durations. Temperatures over 38C (100.4F) usually seen.
• Night sweats or excessive sweating.
• Pain in the bones (long bones) and joints such as hips and knees.
• Swollen lymph nodes (glands) in the neck, armpits and groin.
• Swollen liver and spleen.
• Unexplained weight loss.
• If the central nervous system is affected there may be symptoms such as headaches, vomiting, blurred vision, dizziness and seizures or convulsions.

Symptoms of acute lymphocytic leukaemia (ALL)

Some of the major symptoms such as fatigue, dizziness, palpitations, pallor due to anemia are common in ALL. Other symptoms include:

• There is usually a severe and unusual bone and joint pain.
• There may be a heightened risk of severe infections (oral, throat, skin and groin infections).
• In addition there may be prolonged fever.
• Bleeding and bruising complications may be seen due to low platelet counts. Menorrhagia (excessive menstrual bleeding), nosebleeds and bruising are common.
• There is fullness in the left upper part of the abdomen due to a swollen spleen.
• There may be a large mass or tumour in the chest (mediatrinal mass). This is seen in those with T cell tumors. The mass may press upon the heart and lungs.
• There may be swollen lymphnodes in the neck, groin and armpits. There may be enlargement of the testes.
• Headache, irritability or neck stiffness is seen if the brain is affected. Cranial nerve palsy or paralysis (especially nerves III, IV, VI and VIII) is seen in mature-B cell ALL.

Symptoms of Chronic myeloid leukaemia (CML)

There are several phases of this type of leukemia. Most patients (85-90%) are diagnosed in the chronic phase when there are no symptoms. Symptoms are slow to occur and progress. They include:

• Weight loss
• Fatigue and easy tiredness
• Anemia
• Night sweats
• Swelling of the abdomen due to enlargement of the liver and spleen. An enlarged spleen is the most common physical finding. There may be pain in the abdomen due to splenic infarction.
• Enlarged lymph nodes may be noted
• Bruising and bleeding complications
• Fever
• Gout due to rapid destruction of immature blood cells.
• Hyperviscosity syndrome is seen due to excess white blood cells in blood. This may lead to vision problems like papilloedema, venous obstruction and retinal haemorrhages, painful penile erections (priapism), strokes etc.

Symptoms of chronic lymphocytic leukaemia (CLL)

There may be little or no noticeable symptoms of CLL in early stages. As the condition develops, symptoms include:

• Anemia leading to weakness, breathlessness, pale skin and palpitations.
• Repeated infections
• Unusual bleeding and bruising
• Night sweats
• Swollen spleen and lymph nodes