Acute myeloid leukemia symptoms

While the symptoms of acute myeloid leukemia (AML) can vary, they often include fatigue or weakness and frequent infections or fevers, as well as bruising or bleeding. These symptom clusters arise when cancerous cells crowd out healthy blood cells in the bone marrow, the spongy tissue inside some bones where blood cells develop.

Generally, AML symptoms develop rapidly — within days or weeks — and require urgent evaluation and treatment. Though most symptoms are nonspecific and can have less serious causes, it is important to seek prompt medical care: Many conditions that cause low blood counts, including AML, can lead to serious complications.

Why AML causes symptoms

In AML, cancerous blood cell precursors called blasts grow out of control in bone marrow. These abnormal cells fail to mature into healthy blood cells as they should, crowding the bone marrow and further hampering blood cell production. AML signs and symptoms largely arise from this imbalance between healthy blood cells and leukemia cells.

Key signs, and their results, include:

• low red blood cell counts (anemia): problems with oxygen delivery throughout the body
• low platelets (thrombocytopenia): problems forming clots and controlling bleeding
• low white blood cells (leukopenia): problems fighting infections
• high blast counts: tumor-like masses, blockage of blood flow (leukostasis)

In addition to symptoms related to low blood counts, people with AML may experience other general, or constitutional, symptoms. In rare cases, cancerous cells may also infiltrate other organs and tissues, affecting their function and causing additional symptoms.

Common symptoms of AML

Common signs of AML include constitutional symptoms and symptoms related to low blood cell counts. The disease can vary between individuals, and some people may not experience all common symptoms while others do.

Many of these symptoms can also have causes other than AML. Symptoms alone are not enough to diagnose this leukemia type, so it is important to seek medical evaluation if they occur.

Generally, AML symptoms in adults are similar to those seen in children, although symptoms may develop more rapidly in pediatric patients.

Constitutional symptoms

Constitutional symptoms of AML can include:

• unexplained weight loss
• fatigue
• fever
• night sweats
• appetite loss

AML fatigue can be a constitutional symptom or a sign of anemia.

Constitutional symptoms may be among the early signs of AML. These symptoms have many possible causes — some of which are more likely than AML — but it is a good idea to consult a doctor for further evaluation, particularly if they develop or worsen rapidly.

Anemia

Anemia occurs when there are not enough red blood cells to deliver oxygen throughout the body. Among the symptoms are:

• fatigue
• weakness
• feeling cold or shivery
• dizziness or lightheadedness
• headaches
• pale skin, or pallor
• shortness of breath, even during everyday activities

Paleness can be difficult to notice on darker skin. One way to check for it is to look at the tissue inside the lower eyelid — if it appears white or pale pink, it can be a sign of pallor.

Thrombocytopenia

Platelets are tiny fragments of blood cells that help form clots and prevent bleeding. Symptoms of thrombocytopenia often indicate problems with these processes. In AML, these may include:

• easy or excessive bruising or bleeding, even from minor injuries
• small red or purple spots on the skin (petechiae)
• larger purple, red, or brown blotches on the skin (purpura)
• frequent or severe nosebleeds
• bleeding gums
• heavy menstrual bleeding
• blood in urine or stool, or black, tarry stool

Leukopenia

White blood cells are immune cells, so symptoms of leukopenia are generally related to a weakened immune system. They may include:

• frequent infections
• infections that are difficult to get rid of
• fevers

Infections in AML can be dangerous, particularly because many treatments for the blood cancer also suppress the immune system. People with AML should take steps to avoid infections and should contact a doctor immediately if they experience signs of a new or worsening infection.

Less common symptoms of AML

There are other possible symptoms of AML, most of which are related to the abnormal accumulation or spread of leukemia cells. In some cases, these can cause serious complications. Depending on where and how blasts accumulate, they can cause:

• bone or joint pain, which is more common in children
• abdominal swelling, due to leukemia cell buildup in the liver or spleen

Less often, leukemia cells spread to other tissues and cause additional symptoms. These may include, and be marked by, the following:

• swollen lymph nodes: swollen bumps under the skin in the neck, groin, armpits, or other areas
• skin issues: bumps or rash-like spots on the skin
• problem with gums: swelling, pain, or bleeding in the mouth
• brain and spinal cord issues: headaches, weakness, seizures, vomiting, balance difficulties, facial numbness, or blurred vision

When blast cells form rare tumor-like masses under the skin or in other tissues, it is called a myeloid sarcoma.

Leukostasis is a rare but serious complication of AML that arises when blast cells clog blood vessels, impairing blood flow. This medical emergency can cause stroke-like symptoms such as:

• headache
• difficulty breathing
• loss of muscle control
• seizures
• weakness on one side of the body
• slurred speech
• vision changes
• confusion
• sleepiness
• vomiting

How quickly can AML symptoms develop?

AML is a rapidly progressing cancer. Its symptoms typically develop and progress quickly — usually over a few weeks — becoming more severe as blast levels rise. A person who was feeling healthy and well may suddenly start to feel quite ill over the course of days or weeks. Symptom onset may occur faster in children than in adults.

This is a main difference between AML and chronic myeloid leukemia, which develops very slowly over months to years, with symptoms that are usually less severe.

When AML symptoms need urgent medical attention

Individuals should seek prompt medical advice any time they experience symptoms consistent with AML, as it is a quickly progressing disease. A doctor can run more tests to evaluate symptoms and determine their cause.

People with a known AML diagnosis should ask their care team about when to see a doctor for AML symptoms in their specific case. In general, symptoms that require urgent medical attention include:

• signs of a new or worsening infection, such as high fevers
• uncontrollable or heavy bleeding
• signs of leukostasis, including difficulty breathing, confusion, and vision changes

Because AML symptoms develop rapidly, it’s important not to wait to get checked out.

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