What are the Features of Acute Leukaemias and Why do they Occur?

Even though there are several types of acute leukaemias, as I mentioned in my previous post, the clinical features of all these types are the same. Lets discuss each one of these features one by one and take a clear understanding about the mechanism of their occurrence.

1.      Anaemia

As now we know Leukaemia is abnormal proliferation of the blood forming cells. This process occurs in the bone marrow. As these cells proliferate and give rise to defective cells, the amount of normal cells reduces. Red blood cells are one such type of cell which reduces in number. So, the leukaemic patients present with anaemic features mentioned below.

a.      Exertional dyspnoea – The function of red blood cells is to carry oxygen to peripheral tissues. When we exercise the body requires more oxygen to produce energy to fuel the muscles which contract rapidly. When there are fewer amounts of red blood cells in the blood stream the muscle become lack of oxygen. So, they become exhausted as there is no enough fuel to keep them going.

b.      So, do you have exercise dyspnoea? Do you feel tired when climbing few steps? Do you become breathless even when walking several meters on a flat ground? If your answer to any of these questions is “Yes”, then yes, you have exertional dyspnoea.  

c.       Weakness – This is another symptom which indicates that you may be having anaemia. Do you feel weakness of your body even when you are resting? Do you feel like sleeping all the time? Do feel like your body doesn’t want to move an inch? If “yes” you are feeling weak.

d.      Pallor – So how do you know whether you are pale or not? To find pallor for a non medical person you may have to find someone who is healthy. Then you can compare yours with his/hers. Go in front of the mirror and pull down the lower eye lid and see the colour. Normal people’s colour is reddish pink. If the color is more close to white then you are pale, indicting that you have anaemia. Compare yours with that of someone healthy.

2.      Symptoms due to reduced white blood cells.

White blood cells are security guards of our body. They circulate in our blood stream and destroy any foreign agent (bacteria, viruses) that enters our body and protects our body from various diseases. In leukaemia the white cells are either reduced or defective. So the defective mechanism does not work properly. This gives the opportunity for the infections to get in to our body and produce various diseases. So Leukaemic patients have following symptoms.

·         Fever – The main symptom of infection is fever. So, if you have fever most of the time, then your immune system is defective. Leukaemic patients experience fever most of the time. Some of them have fever all the time. It is more uncomfortable and distressing.

·         Recurrent infections – Leukaemic patients gets more infections. They have more attacks of cough, cold, fever and other diseases.

3.      Symptoms due to reduced platelets

Platelets are also another type of cells which are produced in the bone marrow. As the marrow cells proliferate abnormally, there is less space for the megakaryocytes to divide and produce platelets. The function of the platelets is to produce a blood clot in places where there is an injury in the blood vessels, so more blood wont leak from the damaged vessel. When the platelets reduce in number this process does not occur. So, wherever there is damaged blood vessel, more blood tend leak out in to the skin. This results in bleeding and bruising. Look at your skin carefully. See if there are any bruises that you are not aware about. More the bruises, more the severity of the disease

4.      Lymphadenopathy

Lymphadenopathy means enlarged lymph nodes. So, if you want to find out whether you have Lymphadenopathy, first you have to know where the lymph nodes are. Then you have to carefully palpate those areas to see whether they are enlarged or not. How to palpate lymph nodes will be discussed later in my posts.

5.      Hepatosplenomegally

This is enlargement of the spleen and the liver. Methods to find whether they are enlarged or not, will be discussed later.

6.      Testicular enlargement

7.      Cranial nerve palsies

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.