Leukemia is a group of cancers that begins in the blood-forming tissues, most often the bone marrow. The condition involves the rapid and uncontrolled production of abnormal white blood cells, which interfere with the production of healthy blood components. This article provides objective information about the signs and medical steps involved, but it is not a substitute for a professional medical assessment.
Common Early Indicators
The initial physical signs of leukemia develop because abnormal cells crowd out healthy red blood cells, white blood cells, and platelets in the bone marrow. This disruption leads to symptoms related to the deficiency of each cell type. Persistent weakness or fatigue is a common complaint, resulting from anemia (a low count of oxygen-carrying red blood cells). Anemia can also manifest as paleness of the skin and shortness of breath.
The dysfunctional white blood cells are immature and unable to fight off pathogens effectively, despite often being high in number. This impaired immune function leads to frequent or prolonged infections, often accompanied by recurring fevers, chills, and night sweats. Bleeding and bruising occur easily due to a lack of platelets necessary for blood clotting. Patients may notice tiny red or purple spots under the skin called petechiae, or have unexplained nosebleeds or gum bleeding.
The accumulating abnormal cells can cause bone or joint pain, especially in the larger bones, as the bone marrow cavity becomes full. Other systemic signs include unexplained weight loss, loss of appetite, or a feeling of fullness after eating only a small amount of food. This sensation is often caused by an enlarged liver or spleen, where leukemic cells accumulate outside of the bone marrow.
Common Non-Leukemia Causes of These Symptoms
While the combination of symptoms can be concerning, these indicators are far more commonly caused by less severe or benign conditions. Fatigue, the most reported symptom, is frequently linked to issues like chronic stress, poor sleep hygiene, or non-cancer-related anemias. Iron deficiency anemia, for example, shares the symptoms of pallor and exhaustion but is treatable with dietary changes or supplements.
Recurrent fevers and frequent infections are overwhelmingly caused by seasonal viruses, colds, or influenza. A significant number of conditions unrelated to cancer can also cause easy bruising or bleeding. These include certain medications, such as aspirin or blood thinners, and nutritional deficiencies, particularly in Vitamin C or Vitamin K.
Easy bruising can also be a consequence of aging, where the skin becomes thinner and blood vessels more fragile, or a sign of other non-leukemia blood disorders. Conditions like myelofibrosis, myelodysplastic syndromes, or aplastic anemia are blood-related diseases that present with similar issues like fatigue and bruising. This extensive overlap in symptoms underscores why a medical professional must perform a differential diagnosis to determine the actual cause.
How Leukemia Is Medically Confirmed
The medical investigation for leukemia begins with laboratory tests, primarily the Complete Blood Count (CBC). The CBC measures the number of red cells, white cells, and platelets, often revealing abnormalities such as anemia, low platelet count, or an unusually high white blood cell count. A critical finding suggesting acute leukemia is the presence of blast cells, which are immature white blood cells that should not be circulating in the bloodstream.
If the CBC results are suspicious, a peripheral blood smear is performed, where a pathologist microscopically examines the blood sample for abnormal cell morphology. An abnormal count or the appearance of blast cells prompts the definitive diagnostic procedure: the bone marrow aspiration and biopsy. This procedure involves inserting a specialized needle into the hip bone to extract both liquid marrow (aspiration) and a small piece of solid bone tissue (biopsy).
The collected bone marrow samples are analyzed using specialized techniques like flow cytometry. Flow cytometry uses fluorescently tagged antibodies and a laser to identify specific protein markers on the cell surface. This analysis allows doctors to confirm the presence of leukemia and classify the specific type and subtype. Further genetic and molecular testing, known as cytogenetics, examines the chromosomes within the leukemic cells for specific variations. The presence of certain abnormalities, like the Philadelphia chromosome, helps guide the treatment plan.
Responsible Next Steps
If you are experiencing any persistent, unexplained symptoms, the responsible next step is to schedule an appointment with a Primary Care Physician (PCP). It is helpful to track your symptoms before your visit, noting their duration, frequency, and severity to provide the doctor with a clear picture. Do not wait for symptoms to become severe, especially if they are new and unusual.
Your PCP will perform a physical examination and order initial laboratory screening tests, such as the Complete Blood Count, to begin the diagnostic process. Open and honest communication about your concerns is important, but avoid demanding specific tests or a diagnosis based on self-assessment. The medical team will systematically rule out common causes before pursuing specialized investigations for conditions like leukemia, ensuring a thorough and accurate evaluation.