Signs and Symptoms of Acute Myeloid Leukemia (AML)

Acute myeloid leukemia (AML) can cause many different signs and symptoms.Some are more common with certain subtypes of AML. Overall, the signs and symptoms of leukemia can affect men or women and do not differ by sex or gender.

General symptoms

People with AML often have several non-specific (general) symptoms. These can include:

• Weight loss
• Fatigue
• Fever
• Night sweats
• Loss of appetite

These are not just symptoms of AML. More often they are caused by something other than leukemia.

Symptoms caused by low numbers of blood cells

Many signs and symptoms of AML are the result of a shortage of normal blood cells, which happens when the leukemia cells crowd out the normal blood-making cells in the bone marrow. As a result, people don't have enough normal red blood cells, white blood cells, and blood platelets. These shortages show up on blood tests, and they can also cause symptoms.

Symptoms from low red blood cell counts (anemia)

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

• Tiredness (fatigue)
• Weakness
• Feeling cold
• Feeling dizzy or lightheaded
• Headaches
• Pale skin
• Shortness of breath

Symptoms from low white blood cell counts

Infections can occur because of a shortage of normal white blood cells (leukopenia), specifically a shortage of infection-fighting white blood cells called neutrophils (a condition called neutropenia). People with AML can get infections that don’t seem to go away or may get one infection after another. Fever often goes along with the infection.

Although people with AML can have high white blood cell counts due to excess numbers of leukemia cells, these cells don’t protect against infection the way normal white blood cells do.

Symptoms from low blood platelet counts

Platelets normally help stop bleeding. A shortage of blood platelets (called thrombocytopenia) can lead to:

• Bruises (or small red or purple spots) on the skin
• Excess bleeding
• Frequent or severe nosebleeds
• Bleeding gums
• Heavy periods (menstrual bleeding) in women

Symptoms caused by high numbers of leukemia cells

The cancer cells in AML (called blasts) are bigger than normal white blood cells and have more trouble going through tiny blood vessels. If the blast count gets very high, these cells can clog up blood vessels and make it hard for normal red blood cells (and oxygen) to get to tissues. This is called leukostasis. Leukostasis is rare, but it is a medical emergency that needs to be treated right away. Some of the symptoms are like those seen with a stroke, and include:

• Headache
• Weakness in one side of the body
• Slurred speech
• Confusion
• Sleepiness

When blood vessels in the lungs are affected, people can have shortness of breath. Blood vessels in the eye can be affected as well, leading to blurry vision or even loss of vision.

Bleeding and clotting problems

Patients with a certain type of AML called acute promyelocytic leukemia (APL) might have problems with bleeding and blood clotting. They might have a nosebleed that won’t stop, or a cut that won’t stop oozing. They might also have calf swelling from a blood clot called a deep vein thrombosis (DVT) or chest pain and shortness of breath from a blood clot in the lung (called a pulmonary embolism or PE).

Bone or joint pain

Some people with AML have bone pain or joint pain caused by the buildup of leukemia cells in these areas.

Swelling in the abdomen

Leukemia cells may build up in the liver and spleen, making them larger. This may be noticed as a fullness or swelling of the belly. The lower ribs usually cover these organs, but when they are enlarged the doctor can feel them.

Symptoms caused by leukemia spread

Spread to the skin

If leukemia cells spread to the skin, they can cause lumps or spots that may look like common rashes. A tumor-like collection of AML cells under the skin or other parts of the body is called a chloroma, granulocytic sarcoma, or myeloid sarcoma. Rarely, AML will first appear as a chloroma, with no leukemia cells in the bone marrow.

Spread to the gums

Certain types of AML may spread to the gums, causing swelling, pain, and bleeding.

Spread to other organs

Less often, leukemia cells can spread to other organs. Spread to the brain and spinal cord can cause symptoms such as:

• Headaches
• Weakness
• Seizures
• Vomiting
• Trouble with balance
• Facial numbness
• Blurred vision

On rare occasions AML can spread to the eyes, testicles, kidneys, or other organs.

Enlarged lymph nodes

Rarely, AML can spread to lymph nodes (bean-sized collections of immune cells throughout the body), making them bigger. Affected nodes in the neck, groin, underarm areas, or above the collarbone may be felt as lumps under the skin.

Although any of the symptoms and signs above may be caused by AML, they can also be caused by other conditions. Still, if you have any of these problems, especially if they don't go away or are getting worse, it’s important to see a doctor so the cause can be found and treated, if needed.