Signs and Symptoms of Childhood Leukemia

Red blood cells carry oxygen to all the cells in the body. A shortage of red blood cells can cause symptoms such as:

• Fatigue (tiredness)
• Weakness
• Dizziness or lightheadedness
• Shortness of breath
• Pale skin

Symptoms from anemia may be treated with a blood transfusion.

Platelets in the blood normally help stop bleeding. A shortage of platelets can lead to:

• Easy bruising (or small red or purple dots, called petechiae) and bleeding
• Frequent or severe nosebleeds
• Heavy menstrual bleeding in young women
• Bleeding gums

Bleeding from low platelets can be treated with a platelet transfusion.

Normal white blood cells help the body fight off germs. Children with leukemia can have high or low white blood cell counts. The white blood cells in a person with leukemia may not function well. This can lead to:

• Frequent infections or infections that do not seem to go away
• Fevers, which are caused by infection or inflammation in the body as a response to leukemia cells, without an infection

Infections in children with leukemia can be serious. Fevers are often treated with strong antibiotics and blood cultures are taken to check for bacteria.

Leukostasis is slow or blocked blood flow through small blood vessels because of the high number and large size of blasts. This can cause symptoms of a stroke, like confusion, weakness or numbness, or other symptoms like chest pain or trouble breathing.

Very high white blood cell counts that cause leukostasis can be treated by giving low doses of chemotherapy to clear some of the white blood cells, or with a process called leukapheresis, where a machine filters the white blood cells out of the bloodstream. This requires a catheter to be placed in a large vein, usually in the neck or groin.

Tumor lysis syndrome (TLS) can occur when high numbers of blasts break down in a short period of time and can cause an imbalance in the salts of the blood, like potassium, uric acid, and phosphate. These and other substances from the blasts can build up in the blood. TLS can cause kidney and heart problems if it is not recognized and treated promptly.

TLS is often prevented or managed with fluids and medications. In serious cases, where the kidneys are damaged and salts in the blood build up, kidney dialysis may be needed. This is where a machine does the job of the kidney while it is damaged, removing the extra salts and chemicals. In most cases, if dialysis is needed, it is only for a few days to weeks.

This pain is caused by the buildup of leukemia cells in the bone marrow causing stress on the bone. Some children may limp or refuse to walk because of pain in their bones.

If the spleen and/or liver get big enough, they can press against other organs, like the stomach. This can make the child feel full after eating only a small amount of food, leading to a loss of appetite and weight loss over time.

Leukemia cells can collect in the liver and spleen, making these organs bigger. This might be noticed as fullness or swelling of the belly. The lower ribs usually cover these organs, but when they are enlarged the doctor can often feel them.

Sometimes leukemia cells spread to the lymph nodes, which are normally small (bean-sized) collections of immune cells in the body. Swollen nodes may be seen or felt as lumps under the skin in certain parts of the body (such as on the neck, in the underarm areas, above the collarbone, or in the groin). Lymph nodes inside the chest or abdomen can also swell, but these can only be seen on imaging tests, such as CT or MRI scans.

In infants and children, lymph nodes often get bigger when they are fighting an infection. An enlarged lymph node in a child is much more often a sign of infection than leukemia, but it should be checked by a doctor and followed closely.

Finding lymph nodes above the collarbone or lymph nodes in multiple areas at the same time is more worrisome than lymph nodes in one area like the neck or underarm. Lymph nodes that continue to get bigger or do not reduce in size within days to weeks should be seen by a doctor to find a cause and get treatment, if needed.

An enlarged thymus or lymph nodes in the chest can press on the superior vena cava (SVC), which is a large vein that carries blood from the head and arms back to the heart. This can block the blood from flowing back to the heart. This is known as SVC syndrome. It can result in swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color). Symptoms can also include headaches, dizziness, and a change in consciousness if it affects the brain. SVC syndrome can be life-threatening, so it needs to be treated right away.

Rarely, leukemia in male children can cause one or both testicles to be larger than normal. It is rare for this to happen when leukemia is first diagnosed and is more likely to happen if leukemia returns after treatment.

Most of the symptoms above are more likely to be caused by something other than leukemia. Still, it is important to have these symptoms checked by a doctor so the cause can be found and treated, if needed.

Some types of leukemia can affect structures in the middle of the chest, such as lymph nodes or the thymus (a small organ in front of the trachea, the breathing tube that leads to the lungs). An enlarged thymus or lymph nodes in the chest can press on the trachea, causing a cough or trouble breathing. In many cases this can be life-threatening, so it needs to be treated right away.

A small number of children have leukemia that has already spread to the brain and spinal cord when it is first found. This can lead to symptoms such as headaches, trouble concentrating, weakness, seizures, vomiting, problems with balance, and blurred vision.

In children with acute myeloid leukemia (AML), leukemia cells may spread to the gums, causing swelling, pain, and bleeding.

If AML spreads to the skin, it can cause a red or purple rash. A collection of AML cells under the skin or in other parts of the body can form a lump called a chloroma or granulocytic sarcoma. Juvenile myelomonocytic leukemia (JMML) may also cause skin changes.