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Acute Lymphoblastic Leukemia






Symptoms and Signs

  • Onset is typically 1 to 6 weeks prior to diagnosis (Can range from days to several months)
  • Range of presentation varies widely
  • Children with AML often “sicker” than those with ALL at diagnosis
  • Usually present with:
    • fever
    • lethargy
    • pallor


Symptoms and Signs of ALL:

Cause Symptoms Signs
Bone Marrow involvement Bone Marrow expansion - severe bone pain
  • Bone tenderness
Low Hb - Lethargy & malaise
  • Pallor
  • Lethargy
  • Tachycardia
Low platelet levels - increased tendency to bruise and bleed
  • Petechiae
  • Purpura
  • Bruises
  • Increased risk of bleeding (from mucosal surfaces and internal)
Low WCC /Defective function - Infection
  • Fever and buccal ulcers
Organ involvement Lymph nodes - Often asymptomatic
  • Palpable lymphadenopathy
Liver and Spleen - Abdominal pain and distention
  • Hepatosplenomegaly
Testicles - Testicular pain
  • Enlarged, firm testes
CNS - headache, vomiting and visual disturbance.
  • Cranial nerve palsies and papilledema
  Respiratory – Dyspnea when lying down from mediastinal mass (particularly T-cell ALL)
  • Facial Swelling from superior vena cava swelling.



Purpuric Rash in a baby:  The photograph below shows a "purpuric" rash which is due to small hemorrhages secondary to low platelet counts:




  • Only occurs in less than 5% of patients.


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