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Diagnosis and tests

Symptom map by type

Different types of leukemia cause similar but not identical signs. This topic brings all the main types together on one map: where each sign comes from, which type it is more common in and when urgent help is needed.

Last updated: ~5 min read
Around a translucent human silhouette on a dark navy background are six softly glowing zones in different colours: bones, spleen, lymph nodes, skin, blood vessels and the whole body; no face.
Figure 1.Concept: the signs of six types on one map.

01Short answer

Most signs of leukemia have three causes: a drop in healthy blood cells, leukemia cells collecting in organs and the general effect of the illness. With few red cells come tiredness, pallor and breathlessness; with few platelets, bruising, tiny red spots (petechiae) and bleeding from the nose and gums; with few neutrophils, frequent and lingering infections and fever. In acute leukemias (AML, ALL), signs build quickly over days and weeks; in ALL, bone pain (especially in children) and enlarged lymph nodes, liver and spleen are more common; in T-ALL a mass in the chest can cause cough and breathlessness. In APL, bleeding and a clotting disorder are to the fore, and this is an emergency. In chronic leukemias (CML, CLL), there are often no signs or they develop slowly: in CML an enlarged spleen causes heaviness under the left ribs and feeling full quickly, while CLL typically brings painless lymph nodes and infections. Hairy cell leukemia typically causes a large spleen and low levels of all blood cells. None of these signs is specific to leukemia — only a blood test brings clarity.

02Simple explanation

The bone marrow is like a factory: when leukemia cells take up space, fewer healthy blood cells are made.

Few red cells — tiredness and pallor; few platelets — bruising and bleeding; few neutrophils — infections.

Acute leukemias are like a fast wave: signs build in a short time.

Chronic leukemias are like a slow tide: there may be no signs at all for years.

Some types have their own “signature”: bone pain in ALL, bleeding in APL, a large spleen in CML, lymph nodes in CLL.

03Scientific explanation

The common mechanism. The NCI and NHS explain that leukemia cells multiplying in the bone marrow crowd out normal blood production. The result is anaemia, thrombocytopenia and neutropenia. These three “shortages” explain the main signs of all acute leukemias.

Acute leukemias. According to the ACS, AML can cause weakness, infections, bleeding and bone pain; monocytic forms can cause swollen gums and skin lumps. In ALL, enlarged lymph nodes, liver and spleen and bone and joint pain are more common; in T-ALL a mass in the thymus area can press on the airways or the superior vena cava. In both types, leukemia can affect the linings of the brain — headache, vomiting, vision changes.

APL. The ACS notes that APL cells release substances that disturb clotting, so there is a risk of bleeding from the nose, gums, skin and internally, together with a risk of clots. This situation needs urgent treatment, and when treatment starts in time, APL is among the leukemias with the best outcomes.

Chronic leukemias and HCL. According to the NHS, CML and CLL are often found by chance. CML can cause a large spleen, weight loss and night sweats. CLL can cause painless lymph nodes, frequent infections and sometimes “B symptoms” (fever, night sweats, weight loss). According to CRUK and the NCI, in hairy cell leukemia the spleen enlarges and all blood cells fall, which increases the tendency to infections.

04What happens in the body?

Three shortages, three groups of signs

Anaemia: tiredness, pallor, breathlessness, palpitations. Thrombocytopenia: easy bruising, petechiae, nose and gum bleeding, heavy periods. Neutropenia: repeated or severe infections, fever. These signs can occur in any type but are more marked in acute leukemias.

Three columns on a dark navy background: red blood cells, small platelets and white neutrophils; each column holds fewer cells, with symbols of tiredness, a bruise and a shield beneath; no numbers.
Figure 2.Three shortages, three groups of signs.

Acute leukemias: a fast wave

In AML and ALL, signs build over a few days to a few weeks. In children, ALL often shows up as leg or back pain, limping or not wanting to play. In T-ALL, a cough, breathlessness or a swollen face needs urgent assessment.

Two water scenes side by side on a dark navy background: on the left a quickly rising glowing wave, on the right a calm, slowly rising water level; no people.
Figure 3.Acute leukemia is a fast wave; chronic leukemia is a slow tide.

APL: bleeding comes first

Easy bruising, a nosebleed that will not stop, bleeding gums, blood in the urine or stool, bleeding into the eye. The clotting disorder can be dangerous, so when APL is suspected, treatment starts straight away.

Chronic leukemias: a slow tide

In CML — heaviness under the left ribs, feeling full after small meals, tiredness, night sweats. In CLL — painless lumps in the neck, armpits or groin, infections and sometimes shingles. Often, though, there are no signs at all.

A very high white cell count

When the white cell count is very high, the blood can thicken and flow in small vessels worsens (leukostasis). Headache, vision changes, breathlessness and confusion make this an emergency. It is seen more often in AML and in the acute phase of CML.

05From sign to cause

Behind every sign there is a mechanism.

Crowding out — Leukemia cells take up space in the marrow.1Crowding outLeukemia cells take up space in the marrow.
Shortage — Anaemia, thrombocytopenia, neutropenia.2ShortageAnaemia, thrombocytopenia, neutropenia.
Collecting — Nodes, spleen, liver, gums, CNS.3CollectingNodes, spleen, liver, gums, CNS.
General effect — Fever, sweats, weight loss.4General effectFever, sweats, weight loss.
TirednessFew red cells.
BruisingFew platelets.
InfectionsFew neutrophils.

06Symptom map: the main types

TypeSpeedTypical signsSpecial “signature”
AMLDays–weeksWeakness, infections, bleedingSwollen gums, skin lumps (monocytic forms)
APLDaysBleeding, bruisingClotting disorder — urgent
ALLDays–weeksWeakness, infections, bleedingBone pain, nodes; chest mass in T-ALL
CMLMonths–yearsOften none; tirednessLarge spleen, feeling full quickly
CLLYearsOften none; infectionsPainless lymph nodes
Hairy cellMonths–yearsWeakness, infectionsLarge spleen, all cell counts low

* This table is a generalisation; signs vary from person to person, and none of them is specific to leukemia.

07Key terms

Anaemia
A drop in red cells and haemoglobin.
Thrombocytopenia
A drop in platelets.
Neutropenia
A drop in neutrophils.
Petechiae
Tiny red-purple spots on the skin.
Splenomegaly
An enlarged spleen.
B symptoms
Fever, night sweats and weight loss together.
Leukostasis
Poor flow in small vessels when the white count is very high.
Mediastinal mass
A growth in the centre of the chest above the heart.

08Key points

  • Most signs come from a shortage of healthy blood cells.
  • In acute leukemias, signs build quickly.
  • Chronic leukemias often cause no signs.
  • Bleeding in APL is an emergency.
  • Bone pain and enlarged nodes are more common in ALL.
  • CML typically involves the spleen; CLL, the lymph nodes.
  • No single sign proves leukemia.

09Frequently asked questions

I have bruises. Could it be leukemia?

Most bruises come from knocks, medicines or other causes. But if bruises appear for no reason, are widespread, or come with petechiae or other signs, see a doctor and have a blood test.

My child complains of leg pain. Should I worry?

Leg pain in children is usually linked to growth, knocks or activity. If the pain wakes them at night, does not go away, or comes with limping, fever, pallor or bruising, have a doctor check your child.

I had no symptoms, but CLL was found. Is that normal?

Yes, most cases of CLL are found by chance on a routine blood test. Without symptoms, treatment is sometimes not needed and monitoring is enough.

Are night sweats a sign of leukemia?

They can be, especially together with fever and weight loss. But infections, hormonal changes and medicines are far more common causes. If they last a long time, see a doctor.

Can the type be worked out from the symptoms?

No. Symptoms only point in a direction. The type is determined by the blood film, bone marrow, flow cytometry and genetic tests.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. I have bruises. Could it be leukemia?

  2. My child complains of leg pain. Should I worry?

  3. I had no symptoms, but CLL was found. Is that normal?

  4. Are night sweats a sign of leukemia?

  5. Can the type be worked out from the symptoms?

My questions

12Sources

  1. American Cancer Society. Signs and Symptoms of Acute Myeloid Leukemia (AML)
  2. American Cancer Society. Signs and Symptoms of Acute Lymphocytic Leukemia
  3. American Cancer Society. Signs and Symptoms of Chronic Myeloid Leukemia
  4. American Cancer Society. Signs and Symptoms of Chronic Lymphocytic Leukemia
  5. American Cancer Society. Signs and Symptoms of Childhood Leukemia
  6. NHS. Symptoms of acute myeloid leukaemia
  7. NHS. Symptoms of acute lymphoblastic leukaemia
  8. NHS. Symptoms of chronic myeloid leukaemia
  9. NHS. Symptoms of chronic lymphocytic leukaemia
  10. Cancer Research UK. Symptoms of hairy cell leukaemia
  11. American Cancer Society. Treatment of Acute Promyelocytic Leukemia (APL)
  12. National Cancer Institute (NCI). Leukemia — Patient Version
  13. National Cancer Institute (NCI). Hairy Cell Leukemia Treatment (PDQ®) — Patient Version
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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