Symptoms of leukemia

In typical cases, acute leukemia is characterized by a combination of anemic and intoxication symptom complex (pale mucous membranes and skin with a gray-icteric tint, lethargy, weakness, subfebrile temperature, etc.), proliferative (enlargement of peripheral, mediastinal or abdominal lymph nodes, hepatosplenomegaly, tumor formations of the orbit, flat bones of the skull, etc.) and hemorrhagic syndromes. In addition, often already at the first clinical detection of acute leukemia there may be both clinical and radiological signs of damage to the skeletal system, brain and its membranes (headaches, nausea, vomiting, impaired consciousness, damage to the cranial nerves - most often the sixth pair, paraparesis, paralysis, convulsions, etc.), testicles, leukemic infiltrates on the skin, etc. In many children, one or two syndromes characteristic of acute leukemia appear 4-6 weeks or more before the development of clinical symptoms that allow the correct diagnosis to be made. D. R. Miller (1990) provides a description of 4455 children with acute lymphoblastic leukemia:

• children under one year old - 3%, 1-10 years old - 77%, over 10 years old - 20%;
• boys - 57%, girls - 43%;
• fever - 61%; hemorrhages - 48%; bone pain - 23%; lymphadenopathy - 63% (severe - 17%); splenomegaly - 57% (in 17% the spleen was palpated below the umbilicus), hepatomegaly - 61% (in 17% the lower edge of the liver was below the umbilicus), enlarged mediastinal lymph nodes - 7%, CNS damage - 3%;
• anemia - 80% (in 20% hemoglobin is equal to or more than 100 g/l); thrombocytopenia with a platelet count below 20 thousand per µl - 28%, 20-100 thousand - 47%, equal to or more than 100 thousand - 25%; the number of leukocytes is less than 10 thousand per µl - 51%, 10-50 thousand per µl - 30%, more than 50 thousand per µl - 19%;
• lymphoblast morphology: L1 - 85%; L2 - 14%, L3 - 10%.

With ONLL, proliferative syndromes are less common than with acute lymphoblastic leukemia, but intoxication, anemic and hemorrhagic syndromes, lesions of the central nervous system, bones, gingival hypertrophy, and hyperleukocytosis are more common.

Leukostasis syndrome develops in patients with acute leukemia with a high level of leukocytes in the peripheral blood (more than 100,000 per μl) and is the result of blast aggregation in the capillaries. Most often, it begins with cardiorespiratory disorders with the development of acute respiratory failure and pulmonary edema or with a picture of pneumonia, less often - with phenomena from the central nervous system with a sharp headache or a stroke-like condition.

Infections are a natural complication of acute leukemia as a consequence of the development of primary and secondary immunodeficiency syndrome (a consequence of cytostatic therapy, granulocytopenia). Neutropenia with a neutrophil count of less than 500 per μl is especially dangerous. It is believed that with such severity of neutropenia in the third week, the percentage of layering of infectious complications approaches 100%. Therefore, any fever in children with such severe neutropenia is an indication for active anti-infective therapy (cephalosporins of the third and fourth generations, meronem, imipenem, tazocin, etc.). Against the background of complex cytostatic therapy, whole blood transfusions are dangerous in terms of infection not only with hepatitis B, C, E viruses, but also with herpes viruses, Candida fungi, etc.

In the stage of complete clinical remission, there are no clinical manifestations of acute leukemia, i.e. no deviations from the norm during examination of the child: the percentage of blast cells in the myelogram does not exceed 5%, and the number of lymphocytes in the myelogram is less than 20%; there should be no blast cells in the peripheral blood, but moderate thrombocytopenia and leukopenia are possible due to the cytostatic effect of therapy; there are no deviations from the norm in the cerebrospinal fluid.

Relapse of acute leukemia can be bone marrow (detection of more than 5% blast cells in the myelogram) and extramedullary (“extramedullary”) with various localizations of leukemic infiltration (neuroleukemia, leukemic infiltration of the testicles, spleen, lymph nodes, maxillary sinuses, etc.).

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