Presenting symptoms and signs of acute leukaemia

Abstract

Presenting symptoms and signs of acute leukaemiaChildren with acute leukaemia often present initially to general practitioners or general paediatricians. The clinical features are protean, and the diagnosis may be difficult. A systematic review and meta-analysis of presenting features identified 33 studies of 3084 subjects, who presented with 95 signs and symptoms. Only 6% of children were asymptomatic at diagnosis. The review identified five features each present in over half of the children: hepatomegaly (64%), splenomegaly (61%), pallor (53%), fever (53%) and bruising (52%). Features present in one-third to half were recurrent infections, fatigue, limb pain, bruising/petechiae, lymphadenopathy, bleeding tendency and rash. Abdominal symptoms of anorexia or weight loss (29%), abdominal pain (12%) or distension (11%) were more common than generally recognised. Mucosal bleeding occurred in 25%, while musculoskeletal symptoms included limp (15%) or joint pain (11%). Multiple signs and symptoms were common. These clinical signs may occur in other conditions, but this paper alerts clinicians to signs and symptoms that should rouse suspicion, and prompt them to at least order a blood film.