Leukemia headaches: Pain part two: Headaches | Leukaemia Care
Pain part two: Headaches | Leukaemia Care
As we mentioned last week, certain types of pain can be early warning signs of leukaemia. One such pain often reported to precede diagnoses of leukaemia are headaches. In fact, our latest survey shows that around 10% of leukaemia patients experience headaches as a symptom during the build up to their diagnosis.
Almost everyone gets the occasional headache, and nearly always this is caused by something very harmless such as a cold or the flu, stress, lack of regular meals or fluids (dehydration), or eyesight problems. However, there are a few distinct characteristics of a headache that can, on very rare occasions, indicate an underlying serious condition such as leukaemia.
Spotting leukaemia-related headaches
Some people are prone to developing headaches and are somewhat ‘used’ to getting the occasional headache. This is perfectly normal and, generally speaking, any headache that you’ve had multiple times over a period of years, without developing other symptoms, is almost certainly harmless.
It is the “new headaches” or headaches that feel different from any you’ve had before that are worth visiting your GP about.
“I had a banging headache where I could hear my heartbeat in my ears so loud my head felt like it was throbbing, and it would not go away when I lay down.”
When headaches are caused by leukaemia, they are likely to occur frequently and are often severe and long lasting. Many leukaemia patients report waking up in the middle of the night with a headache, along with night sweats and other fever-like symptoms such as general achiness.
However, this does not mean that you should rush to A&E every time you have a fever and a headache. Relatively harmless infections such as the common cold or influenza (flu) are a much more likely cause of fever and headaches. If your symptoms feel unfamiliar or worse to any cold or flu you’ve had before, then you should make an appointment with your doctor.
When should I be concerned?
If you can relate to any of the following descriptions, it is important that you visit your doctor.
- A sudden, excruciating headache that quickly becomes unbearably painful to the point where you can’t move. Sometimes called a “thunderclap headache”, this is the most concerning type of headache as it can be caused by a life-threatening bleed on the brain. A headache of this nature is an emergency and warrants calling 999.
“It was the worst headache of my life.”
- A new headache that feels different from any headache you have experienced in the past. Or a noticeable increase in frequency or intensity.
“I decided to see my GP because I was having daily headaches which were getting worse and worse, making work very difficult.”
- A new headache that comes on after 40 years of age with no prior experience of headaches.
- A headache that is waking you up at night.
- A headache accompanied by other symptoms. In the case of leukaemia, this might be visual impairment, vertigo, hearing loss or any of the other more common symptoms of leukaemia (see here).
“I became bed bound with debilitating headaches, bruises, drenching night sweats, fatigue, no appetite, nausea, weight loss, nose bleeds and bone pain.”
Causes of headaches in leukaemia
In leukaemia, cancerous white blood cells can start to crowd out the healthy red blood cells in the bone marrow, causing anaemia. This means that a lower amount of oxygen is able to reach the tissues, including the brain. Low levels of oxygen in the brain can cause the surrounding arteries to swell, leading to headaches.
Other symptoms of leukaemia-related anaemia include weakness and fatigue, breathlessness, pale skin, dizziness and poor concentration.
- Leukaemia cells entering the Central Nervous System (CNS)
Leukaemia can also cause your white blood cell count to rise to a dangerously high level. Excess levels of white blood cells can cause the blood to thicken and clog up the small vessels that supply the brain. As well as headaches, this can also lead to symptoms such as nausea, double vision, vertigo, weakness, and sometimes seizures.
- Enlarged thymus
A certain subtype of leukaemia called T- cell acute lymphoblastic leukaemia (T-ALL) often affects the thymus gland, a small organ located in the upper chest. In people with T-ALL, the thymus can sometimes become enlarged and can push up against a large vein that pumps blood back from the head to the heart (the Superior Vena Cava). This is known as SVC syndrome, and if it affects blood flow out of the brain it can cause headaches, dizziness and feelings of confusion.
Other symptoms of SVC syndrome include a swollen face, neck, arms and upper chest.
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.
People with AML often have several non-specific (general) symptoms. These can include:
- Weight loss
- 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)
- Feeling cold
- Feeling dizzy or lightheaded
- 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:
- Weakness in one side of the body
- Slurred speech
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:
- 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.
What Are Some of the Common Symptoms of Leukemia?
Signs and symptoms of leukemia will vary depending on the type of leukemia you have.
All people with leukemia will experience some degree of cytopenia, which is a deficiency in mature blood cells. This is because, as abnormal leukemia cells grow in the bone marrow, they crowd out the cells normally produced there.
Patients may not have enough normal red blood cells, a condition called anemia. Common symptoms include:
A shortage of white blood cells, which are designed to ward off or fight infection, may result in infections that don’t go away.
Low blood platelet counts are another common problem people with cytopenia face. Having a shortage of platelets can cause excessive bruising or bleeding; frequent or severe nosebleeds; and bleeding gums.
People with acute forms of the cancer usually notice more symptoms because the disease progresses faster. Those with chronic leukemias may not know they have cancer until they take a routine blood test.
Some symptoms of leukemia are vague and general, making it a somewhat difficult cancer to detect. (1,2)
Common Symptoms of Leukemias
The symptoms you experience will depend on whether your disease is chronic or acute and the type of blood cells it affects. But certain symptoms overlap and are common in all forms of the cancer.
Some general symptoms of leukemia include:
- Night sweats
- Unexplained weight loss
- Loss of appetite
Most of the time, these symptoms are caused by another illness, and not leukemia (3)
Symptoms of Acute Lymphocytic Leukemia (ALL)
Most symptoms of ALL occur because a person lacks an adequate amount of normal blood cells. Problems due to low blood cell counts include:
- Feeling tired or weak
- Dizziness or light-headedness
- Shortness of breath
- Infections that come back or don’t go away
- Easy bruising or bleeding
If leukemia cells build up in the liver and spleen, you may feel full after only eating a small meal or notice swelling in your belly.
Sometimes, leukemia can cause bone or joint pain from the cells growing in the bone marrow.
If ALL spreads to other places in your body, you may experience symptoms such as:
- Enlarged lymph nodes (if the cancer spreads to lymph nodes)
- Headaches, weakness, seizures, vomiting, facial numbness, blurred vision, or balance issues (if the cancer spreads to your brain or spinal cord)
- Fluid buildup and breathing difficulties (if the cancer spreads to your chest)
A subtype of ALL can affect the thymus, a small organ in the middle of your chest. An enlarged thymus can cause coughing or trouble breathing. It can also press on the superior vena cava (SVC) — a large vein in your body. If this happens, blood can back up in the veins and cause a serious condition that’s characterized by swelling in the face, neck, arms, and chest; headaches; dizziness; and a change in consciousness.(4)
Symptoms of Acute Myeloid Leukemia (AML)
If the AML cancer cells, called blasts, become very high in number, they can cause a serious condition known as leukostasis, which literally means slowing of the normal blood flow due to congestion. This can lead to symptoms such as:
- Slurred speech
- Weakness on one side of the body
- Shortness of breath
- Blurry vision or loss of vision
Some people with AML may have bone or joint pain if the leukemia builds up in the bone marrow in these areas.
If AML spreads to the skin, it can cause spots that look like a rash. Certain types of AML may affect the gums, causing pain, swelling, and bleeding. Enlarged lumps under the skin of the neck, groin, underarms, or collarbone are a sign that the cancer has spread to your lymph nodes.
When cancer cells collect in the liver or spleen, the organs may enlarge and cause swelling of the abdomen or a feeling of fullness.
People with a certain type of AML, known as acute promyelocytic leukemia (APL), may have bleeding and clotting problems.
If AML spreads to your brain or spinal cord, it could cause:
- Balance difficulties
- Blurred vision
- Numbness in the face
Symptoms of Chronic Lymphocytic Leukemia (CLL), Also Known as Small Lymphocytic Lymphoma (SLL)
People with CLL may not have any symptoms when the cancer is diagnosed. Over time, they may gradually notice certain issues.
Anemia can affect someone with CLL, causing weakness, tiredness, and shortness of breath.
CLL is a cancer of B lymphocytes, which usually work to help fight infections. People with CLL may also have a high or low white blood cell count. Because their bone marrow is producing too many abnormal white blood cells, they don’t have enough normal cells. As a result, they may experience frequent infections that don’t go away on their own.
Bruising, bleeding, frequent nosebleeds, and bleeding gums may occur when you have a shortage of platelets in your blood.
If CLL affects your liver or spleen, you may feel full after only a small meal or experience swelling in your belly.
Enlarged lymph nodes are another sign of CLL. (6)
Symptoms of Chronic Myeloid Leukemia (CML)
People with CML often experience many of the same symptoms as those with CLL.
The most common sign of CML is an abnormal white blood cell count on a blood test. Very high or low white blood cell counts can lead to frequent infections that are hard to fight off.
A shortage of red blood cells can cause weakness, tiredness, and shortness of breath.
Too few platelets in the blood can trigger nosebleeds; easy bruising or bleeding; or bleeding gums. Some people with CML have too many platelets in their blood, which can also cause bleeding and bruising issues because the platelets don’t work properly.
A feeling of unusual fullness after eating or swelling in the abdomen are also common symptoms if the cancer affects your spleen or liver.
Additionally, some people with CML may complain of bone or joint pain if leukemia cells spread from the marrow to the surface of the bone or joint. (7)
What to Do if You Have Symptoms
It’s a good idea to see your doctor if you have signs or symptoms that are unusual, severe, or don’t go away.
Leukemia symptoms are often overlooked because they can mimic those of other common illnesses, such as the flu.
If your physician suspects leukemia, he might perform a physical exam, routine bloodwork, or a bone marrow test (a procedure to remove a sample of bone marrow from your hip). (8)
Headaches | Cancer.Net
Almost everyone gets a headache from time to time. There are 2 main types of headaches, and both types are common in people with cancer:
Primary headaches. These include migraines, cluster headaches, and tension headaches. Tension headaches are also called muscle contraction headaches.
Secondary headaches. These are from other medical conditions or underlying factors. These may be caused by a brain tumor, head injury, infection, or medicines.
Managing side effects, which can include headaches, is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms you or the person you are caring for experience.
Headaches may have different symptoms. These factors help describe them:
Timing. This is the time of day when you develop a headache. Sometimes, the timing of a headache provides a clue to its cause. For example, headaches later in the day are often tension headaches.
Frequency. This is how often you have a headache. For example, occasionally, weekly, or daily.
Triggers. These are the factors that start a headache. Triggers can include exposure to cold, blinking lights, loud noises, or specific foods.
Duration. This is how long the headache lasts. It may range from minutes to hours to days. Some headaches start and end very suddenly. Others come and go over several hours or days.
Location. This is the place where the pain occurs. For example, pain may develop in these places:
Severity. This is the level of pain. It may range from mild to severe and incapacitating. Incapacitating means that you have difficulty moving or speaking during the headache. Some headaches start with mild pain that gradually becomes severe. Other times, they start with severe pain and remain that way.
Quality. This is the type of pain you experience. You may describe it with words such as:
Stabbing or piercing
A feeling of pressure
A dull ache
In addition to the headache itself, you may experience symptoms related to the headache, including:
Nausea and vomiting
Sensitivity to light or noise
Difficulty moving or speaking
Pain that increases with activity
Consider keeping a headache diary to track these symptoms. This will help your doctor diagnose and treat your headaches.
Causes of headaches
The following factors can cause a headache:
Cancer. Certain cancers may cause a headache, particularly these types:
Cancers of the brain and spinal cord
Pituitary gland tumors
Cancer of the upper throat, called nasopharyngeal cancer
Some forms of lymphoma
Cancer that has spread to the brain
Infections. Sinusitis and meningitis can cause headaches. Sinusitis is an infection of the sinuses. These are hollow passages in the bones around the nose. With meningitis, the protective membranes covering the brain and spinal cord swell.
Cancer treatment. The following cancer treatments can cause headaches:
Some types of chemotherapy, such as fluorouracil (5-FU, Adrucil) and procarbazine (Matulane)
Radiation therapy to the brain
Immunotherapy, a treatment that boosts the body’s natural defenses to fight cancer
Other medicine. Medicine for cancer-related symptoms or other conditions can cause headaches:
Antibiotics, used to treat infections
Antiemetics, used to prevent or treat vomiting
Cancer-related side effects or other conditions. Symptoms or side effects related to cancer or cancer treatment can also cause headaches:
Anemia, a low red blood count
Hypercalcemia, a high level of calcium
Thrombocytopenia, a low platelet count
Dehydration, a loss of too much water from the body. This may be caused by severe vomiting or diarrhea.
Other factors. Stress, fatigue, anxiety, and sleeping problems may also cause headaches.
Your health care team will assess your symptoms and medical history. They will also conduct a physical exam. This information will help determine the headache type and cause.
Tell the health care team if you have headaches with these features:
They are frequent or severe.
They wake you at night.
They have new patterns or a change in frequency.
They are new or exhibit new symptoms.
Your doctor may also order tests to help diagnose the cause of your headaches:
A computerized tomography (CT) scan. This makes a 3-dimensional picture of the inside of the body.
Magnetic resonance imaging (MRI) of the brain. This uses magnetic fields to produce detailed images of the body.
Other tests, based on the headache pattern and symptoms
Treating and managing headaches
When possible, doctors treat the condition that causes the headache. This can be done using medication or other strategies.
These medications may prevent and treat headaches or reduce the pain:
Over-the-counter pain relievers, like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)
Prescription narcotic pain relievers, like codeine
Triptan medications, like sumatriptan (Alsuma, Imitrex, Zecuity)
Steroid medications, especially for headaches caused by cancer that spreads to the brain
Antibiotics, if an infection is causing the headache
Tell your health care team about any over-the-counter pain medication you take.
The following may help reduce the number and severity of headaches:
Get enough sleep.
Some complementary therapies may also help relieve and prevent headaches. This can include techniques such as:
Talk with your health care team about controlling your headaches with complementary therapies.
Evaluating Complementary and Alternative Therapies
Leukemia: Symptoms and early signs
Leukemia is a general term for cancers that affect a person’s blood or bone marrow. Different leukemia types exist, but many cause similar signs and symptoms due to their effect on blood cells.
In this article, we look at the different symptoms of leukemia and explain why they occur and when a person should see a doctor. We also briefly discuss the causes and risk factors, diagnosis, and treatment options.
Share on PinterestA person’s age and type of leukemia may determine the symptoms of the disease.
Leukemia symptoms may vary according to the person’s age, as well as the type of leukemia and stage of the disease.
Recognizing the signs of leukemia in a child can be difficult. A child may not be able to describe their symptoms as easily as an adult could.
Some of the most common signs and symptoms of childhood leukemia include:
- loss of appetite
- bleeding gums
- bone pain
- easily bleeding
- easily bruising
- fever without other signs of infection
- frequent coughing
- frequent infections that seem to take longer to go away or infections that keep coming back
- joint pain
- problems breathing
- swollen lymph nodes that the person may feel under the arms, above the collarbone, or in the groin
- unexplained fatigue
- unintentional weight loss
Many of these symptoms can resemble those of other childhood illnesses, such as the flu, respiratory syncytial virus, or pneumonia.
The symptoms of leukemia in adults can range from general feelings of being unwell to abdominal swelling due to problems with the spleen — an immune system organ.
A person may experience the following symptoms.
1. Nonspecific symptoms
Sometimes, a person can experience flu-like symptoms that they would not necessarily associate with leukemia. These symptoms are usually due to the destruction of blood cells in the body and the increased amount of energy that the body needs to fight off the disease.
A person may often relate these symptoms to their leukemia once a doctor diagnoses them.
2. Abdominal swelling
As leukemia cells multiply, they may start to build up in the spleen and the liver. The presence of excess cells can cause these organs to enlarge. As a result, a person may experience feelings of abdominal fullness or swelling.
3. Bleeding problems
Some types of leukemia can destroy platelets, a blood cell type responsible for helping stop bleeding. As a result, a person may notice that they bleed more easily if they have a cut. They may also have bleeding gums or frequent nosebleeds.
4. Bone or joint pain
Abnormal cells can build up near or inside bones, which can cause unexplained bone or joint pain. This pain can range from a dull ache to severe pain and discomfort.
5. Increased incidence of infections
Leukemia can destroy the white blood cells that help fight off infections. As a result, people with the condition can experience higher rates of infection and fever due to low white blood cell counts.
A person may feel as though they are always sick and fighting off various viral and bacterial illnesses. They may also have a low grade fever.
6. Lymph node enlargement
Lymph nodes are a key aspect of the body’s immune system as they filter fluid and potentially harmful substances from the body. If leukemia cells spread and multiply, they may reach lymph nodes in the body.
A person or doctor may be able to feel the lymph nodes as fluid-filled lumps under the skin.
Common locations where lymph node enlargement may occur include:
- either side of the groin
- the sides of the neck
- under the arms
Sometimes, the lymph node swelling is not to a degree where a person can feel the swollen nodes.
7. Superior vena cava (SVC) syndrome
Some people have a form of leukemia that affects T cells in the thymus. The thymus is a gland near the trachea, or windpipe, that acts as an immune and endocrine system organ.
If leukemia cells are present in the thymus, the gland can start to swell and place pressure on the SVC. This large vein transports blood to the heart from the upper body.
The pressure from the thymus on the SVC can cause blood to back up in the veins, which can lead to dizziness, headaches, and swelling of the chest, arms, face, and neck. Some people may even experience changes in thinking and consciousness because of affected blood flow from the vein.
SVC syndrome is a serious medical complication of leukemia that requires immediate medical treatment.
Leukemia does not always cause symptoms in the early stages. Often, the initial symptoms closely resemble those of the flu, but unlike flu symptoms, they then do not go away.
Examples of common early leukemia symptoms include:
- loss of appetite
- bone pain
- easily bruising
- frequent infections
- heavy bleeding
- joint pain
- night sweats
- shortness of breath
If a person’s symptoms do not go away over a few weeks, they should talk to their doctor.
Doctors may classify leukemia as either acute or chronic. Acute leukemia comes on suddenly, and the cancerous cells multiply rapidly. Chronic conditions result from slowly developing cancer cells, and it may take years before a person experiences any symptoms.
However, acute and chronic leukemia have some similarities. They both cause flu-like symptoms, fatigue, and general feelings of being unwell.
Examples of chronic leukemia symptoms include:
- loss of appetite
- discomfort or a feeling of fullness in the upper abdomen on the left side (where the spleen sits)
- easily bruising or bleeding
- easily becoming fatigued
- enlarged lymph nodes that are not painful to the touch
- night sweats
- weight loss
Acute leukemia symptoms may include:
- bone aches
- cuts that are slow to heal
- fatigue that does not improve with rest
- infections that will not go away
- joint aches
- low grade fever
- night sweats
- pale skin
- small red dots underneath the skin that doctors call petechiae
These are just some examples of acute and chronic leukemia symptoms. A person may experience other symptoms instead or in addition.
A person should see their doctor if they experience the following symptoms, which may be due to leukemia:
- loss of appetite
- a low grade fever that does not go away
- frequent and prolonged infections
- unexplained fatigue
- unexplained weight loss
If a person has other symptoms that represent changes to their medical history and affect their well-being, they should talk to their doctor.
Doctors have not identified one single underlying cause of leukemia. Instead, they think that multiple factors can affect the likelihood of a person getting the disease. These factors include:
- older age
- having a close relative, such as a parent or sibling, who had leukemia
- history of chemotherapy or radiation for other cancer treatments
- history of cigarette smoking
- history of exposure to chemicals, such as Agent Orange or benzene
- history of exposure to high radiation levels
However, just because a person has these risk factors, it does not mean that they will get leukemia.
Doctors usually diagnose leukemia using a combination of blood tests to determine the average levels of certain blood cells. A doctor may also take a bone marrow biopsy to identify cancerous cells or the presence of other harmful cells in the body.
The treatment options for leukemia depend on the type of leukemia that a doctor diagnoses the person as having.
Examples of possible treatments include:
- immune-modulating drugs
- immunosuppressive therapies
- splenectomy, which is the surgical removal of the spleen
- stem cell transplants
Again, the best treatment will depend on the underlying cause of leukemia, as some types of leukemia respond differently to certain treatment approaches.
Survival rates for people with leukemia vary depending on various factors, including the type of leukemia, the person’s age at diagnosis, and how early a doctor makes the diagnosis.
A person with a diagnosis of leukemia should talk to their doctor about their likely survival rate and how treatments may change their outlook.
Leukemia can cause a variety of symptoms. Initially, a person may dismiss the symptoms as being due to a viral or bacterial illness. Further blood tests may reveal lower-than-expected blood counts and lead a doctor to conduct more diagnostic tests.
If a person suspects that their symptoms could indicate leukemia, they should talk to their doctor.
Myelodysplastic Syndrome | Cedars-Sinai
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Myelodysplastic syndromes affect blood cell production and behavior. Blood carries oxygen, chemicals and hormones to the cells in the body and helps remove toxins and waste. Bone marrow (the spongy middle part of the large bones) produces the three main types of blood cells.
- Red blood cells carry oxygen to the tissues (muscles, bones, nerves and organs). Low red blood counts or malfunctioning red blood cells can cause anemia. Symptoms are paleness, feeling tired, fast-beating or pounding heart, dizziness, shortness of breath or headaches.
- White blood cells fight infection. Symptoms of infection caused by low white blood counts may include temperature rising to 38.0 C or 100.4 F, coughing, stiff neck, pain or burning with urination, sore throat, mouth or lip sores and sores that do not heal.
- Platelets help to prevent bleeding. Signs of inadequate platelets include bleeding or bruising too easily. Patients may experience bleeding of the gums when brushing their teeth, blood in the urine or stool, severe headache or visual changes or a stiff neck.
The five categories of MDS are:
- Refractory anemia
- Refractory anemia with ringed sideroblasts
- Refractory anemia with excess blasts
- Refractory anemia in transformation to acute leukemia
- Chronic myelomonocytic leukemia
The disease categories on the lower end of this list are more serious and have a worse prognosis than those at the top. Refractory anemia and refractory anemia with ringed sideroblasts primarily affect the red blood cells and are the most common forms of MDS. Refractory anemia with excess blasts is present when immature white blood cells are found in the bone marrow in abnormally large numbers (five to 20 percent bone marrow blasts, compared to normal blasts of less than one percent). Refractory anemia with excess blasts in transformation occurs when blasts become markedly increased (more than 20 percent) and may indicate that MDS will change to an acute form of leukemia.
When symptoms of Myelodysplastic Syndrome appear, they are usually subtle. MDS may remain stable for several years, or it may get worse quickly and progress to acute myeloid leukemia.
The most common symptoms are:
- Signs of anemia, such as weakness, tiredness, headaches, heart palpitations and dizziness
- Low platelet counts cause easy and profuse bleeding, as well as unexplained bruising
- Women may experience heavy menstrual periods
- Susceptibility to infection due to low number of white blood cells
Causes and Risk Factors
MDS may begin without any apparent cause.
Possible risk factors include:
- Exposure to certain chemicals, such as pesticides
- Exposure to chemotherapy or non-chemotherapy drugs and radiation
- Age may also be a factor since MDS is most commonly diagnosed in people 60 and older
MDS is difficult to diagnose because of the absence of symptoms in the early stage of the disease. Often it is accidentally discovered during a routine physical exam or blood test. Routine screening tests do not exist for MDS, but if the disease is suspected, the doctor may order these tests:
- Complete blood count. A small amount of blood is drawn from the arm, and the lab measures red blood cells, white blood cells and platelets in the sample.
- Bone marrow biopsy
- An examination of the chromosomes that carry genetic material
MDS is a progressive disease. As bone marrow becomes more affected, blood cells become more abnormal. Since no current therapies are effective in preventing MDS from worsening, treatment usually focuses on relieving the symptoms. Doctors will discuss with the patient the various options available, including:
- Red blood cell or platelet transfusions
- Biologic therapy
- Differentiating agents (drugs)
- Bone marrow transplant
- Leukemia treatment
MDS may change into acute myelogenous leukemia (AML). AML causes large numbers of immature white blood cells to be produced by the bone marrow. When this occurs, the patient is treated for AML rather than MDS. Patients with refractory anemia with excess blasts and chronic myelomonocytic leukemia have a higher risk of progression.
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
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Signs and Symptoms | Leukemia and Lymphoma Society
In the early stages of myeloma, some patients have no signs or symptoms of the disease. It is sometimes detected before symptoms appear, when results of laboratory tests done as part of a routine medical examination show abnormalities in the blood and/or urine. When symptoms are present, the most common ones are bone pain and fatigue.
Doctors sometimes refer to the acronym, CRAB, to describe signs of myeloma. The letters stand for
- C – Calcium elevation (high levels of calcium in the blood; also known as “hypercalcemia”)
- R– Renal insufficiency (poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys)
- A – Anemia (low red blood cell counts)
- B – Bone abnormalities (lesions).
Patients with one or more of these CRAB criteria are considered to have disease that requires therapy. Those who do not exhibit any of these criteria are said to have “smoldering” or “asymptomatic myeloma,” and these patients may be followed with a watch-and-wait approach.
Some other symptoms of myeloma include:
- Bone pain and/or skeletal fractures. Bone pain is the most common early symptom of myeloma. Bones are constantly in a process of remodeling, maintaining a balance between bone destruction and formation. Myeloma causes an imbalance, with greater bone destruction and less new bone formation. This may result in bone thinning (osteoporosis) or holes in the bones (lytic lesions). Bones may break easily from activities as simple as coughing. The damage is most commonly found in the back or ribs, but it can occur in any bone. The pain is usually constant and made worse by movement. Bone lesions are present in
about 80 percent of myeloma patients, most commonly in the spine and pelvis, but could affect any bone. Bone lesions are not usually found in joints.
- Fatigue and weakness as a result of low red blood cell counts (anemia). Myeloma patients may fatigue more easily and feel weak. They may also have a pale complexion from anemia.
- Frequent infections due to a weakened immune system. Myeloma patients may experience repeated infections because the antibodies they need to fight invading viruses, bacteria or other disease agents are not made efficiently or in adequate numbers. A urinary tract, bronchial, lung, skin or other type of infection may be the first sign of the disease. In addition, recurrent infections may complicate the course of the disease.
Other signs and symptoms include:
- Damage to kidneys from high levels of antibodies (proteins). The patient’s urine may look foamy and the patient’s legs may swell.
- Numbness, tingling, burning or pain in the hands or feet (caused by a condition called “peripheral neuropathy”).
- Some patients have high levels of calcium, which can cause increased confusion, increased blood pressure, nausea/vomiting, constipation and excessive thirst.
- In rare cases, patients can have hyperviscosity syndrome, when the blood thickens. Symptoms of hyperviscosity syndrome are abnormal bleeding, headaches, chest pain, decreased alertness or shortness of breath.
- Some patients can have amyloidosis, a condition in which the abnormal myeloma protein is deposited in various tissues in the body, causing damage.
If you experience by any of the above symptoms, see your doctor. Sometimes, you may have no symptoms. In this case, your doctor may first detect the disease as a result of a lab test or an X-ray taken for another reason.
- Download or order The Leukemia & Lymphoma Society’s free booklet, Myeloma.
Leukemia is a malignant disease in which the process of hematopoiesis is disrupted in the bone marrow. As a result, a large number of immature leukocytes enter the bloodstream, which cannot cope with their main function – to protect the body from infections. Gradually, they displace healthy blood cells, and also penetrate into various organs, disrupting their work.
Blood cancer is one of the most common cancers that occurs in both children and adults.The prognosis of the disease depends on many factors: the type of leukemia, the patient’s age, concomitant diseases. Over the past decades, methods for effective treatment of leukemia have been developed and are constantly being improved.
Leukemia, leukemia, blood cancer.
Leukemia, leucosis, bloodcancer.
Symptoms of leukemia can develop acutely or gradually.They are nonspecific, depend on the type of leukemia and in the initial stages may resemble the flu or other infectious disease.
The symptoms of leukemia are:
- frequent infectious diseases;
- weakness, malaise;
- Frequent prolonged bleeding;
- hematomas, hemorrhages on the skin and mucous membranes;
- enlarged lymph nodes;
- unreasonable weight loss;
90,027 abdominal pain;
General information about the disease
All blood cells – leukocytes, erythrocytes, platelets – are formed in the bone marrow – a specific hematopoietic tissue located in the pelvic bones, sternum, vertebrae, ribs, long bones. It contains stem cells that give rise to all blood cells. In the process of division, lymphoid and myeloid stem cells are first formed from them. From lymphoid stem cells, lymphoblasts are formed, and from myeloid stem cells – myeloblasts, as well as precursors of erythrocytes and platelets.Leukocytes are obtained from lymphoblasts and myeloblasts. Blasts differ from mature leukocytes in structure and function and must go through a series of successive divisions, during which more and more specialized progenitor cells are formed. After the last division, mature, functional blood cells are formed from the precursors. Thus, lymphoid stem cells form lymphocytes (a type of leukocytes), and from myeloid stem cells – erythrocytes, platelets and other types of leukocytes (neutrophils, basophils, eosinophils and monocytes).These are mature blood cells capable of performing their specific functions: red blood cells deliver oxygen to tissues, platelets provide blood clotting, leukocytes – protection against infections. After completing their task, the cells die.
The entire process of division, death and maturation of blood cells is embedded in their DNA. When it is damaged, the process of growth and division of blood cells, mainly leukocytes, is disrupted. A large number of immature white blood cells that are unable to perform their function enter the bloodstream, and as a result, the body cannot cope with infections.Immature cells divide very actively, live longer, gradually displacing other blood cells – erythrocytes and platelets. This leads to anemia, weakness, frequent prolonged bleeding, hemorrhages. Immature leukocytes can also enter other organs, disrupting their function – the liver, spleen, lymph nodes, and the brain. As a result, the patient complains of pain in the abdomen and head, refuses to eat, and loses weight.
Depending on what type of leukocytes is involved in the pathological process and how quickly the disease develops, the following types of leukemia are distinguished.
- Acute lymphoblastic leukemia is a rapidly developing disease in which more than 20% of lymphoblasts appear in the blood and bone marrow. It is the most common type of leukemia that occurs in children under 6, although adults are also prone to it.
- Chronic lymphocytic leukemia progresses slowly and is characterized by an excessive amount of mature small round lymphocytes in the blood and bone marrow, which can penetrate into the lymph nodes, liver, and spleen.This type of leukemia is typical for people over 55-60 years old.
- Acute myeloid leukemia – with it, more than 20% of myeloblasts are found in the blood and bone marrow, which are continuously dividing and can penetrate into other organs. Acute myeloid leukemia often affects people over 60, but it also occurs in children under 15.
- Chronic myelocytic leukemia, in which the DNA of the myeloid stem cell is damaged. As a result, immature malignant cells appear in the blood and bone marrow along with normal cells.The disease often develops imperceptibly, without any symptoms. Chronic myeloid leukemia can get sick at any age, but people 55-60 years old are most susceptible to it.
Thus, in acute leukemia, a large number of immature, useless leukocytes accumulates in the bone marrow and blood, which requires immediate treatment. In chronic leukemia, the disease begins gradually, more specialized cells enter the bloodstream, capable of performing their function for some time.They can go on for years without showing themselves.
Who is at risk?
- Those who have been exposed to radiation, including during radiation therapy and frequent X-ray examinations
- Long-term contact with chemicals such as benzene or formaldehyde.
- Underwent chemotherapy.
- Suffering from myelodysplastic syndrome, that is, diseases in which the bone marrow does not produce enough normal blood cells.
- People with Down syndrome.
- People whose relatives had leukemia.
- Infected with type 1 T-cell virus, which causes leukemia.
Basic methods of diagnosis of leukemia
- Complete blood count (without leukocyte count and ESR) with leukocyte count – this study gives the doctor information about the amount, ratio and degree of maturity of blood elements.
- Leukocytes.The white blood cell count in leukemia can be very high. However, there are leukopenic forms of leukemia, in which the number of leukocytes is sharply reduced due to the suppression of normal hematopoiesis and the predominance of blasts in the blood and bone marrow.
- Platelets. Usually the platelet count is reduced, but in some types of chronic myeloid leukemia, it is increased.
- Hemoglobin. The level of hemoglobin, which is part of red blood cells, can be reduced.
Changes in the level of leukocytes, erythrocytes, platelets, the appearance of leukocytes, the degree of their maturity allow the doctor to suspect leukemia in the patient.Similar changes in the ratio of blood cells are possible in other diseases – infections, immunodeficiency states, poisoning with toxic substances – but they lack blasts in the blood – the precursors of leukocytes. The blasts have characteristic features that are clearly visible under a microscope. If they are found in the blood, it is highly likely that the patient has one of the types of leukemia, so further testing is needed.
- Leukocyte formula is the percentage of different types of leukocytes in the blood.Depending on the type of leukemia, different types of leukocytes predominate. For example, in chronic myeloid leukemia, the level of neutrophils usually increases, basophils and eosinophils can be increased, and their immature forms predominate. And in chronic lymphocytic leukemia, most of the blood cells are lymphocytes.
- Bone marrow biopsy – taking a sample of bone marrow from the sternum or pelvic bones using a fine needle, which is performed after anesthesia. Then, under a microscope, the presence of leukemic cells in the patient’s bone marrow is determined.
Additionally, the doctor may prescribe:
- Lumbar puncture to detect leukemic cells in the cerebrospinal fluid that bathes the spinal cord and brain. CSF is sampled using a fine needle inserted between the 3rd and 4th lumbar vertebrae after local anesthesia.
- Chest X-ray – May show enlarged lymph nodes.
- Cytogenetic study of blood cells – in difficult cases, an analysis of the chromosomes of blood cells is performed and thus the type of leukemia is determined.
The tactics of treating leukemia is determined by the type of disease, the age of the patient and his general condition. It is carried out in specialized hematology departments of hospitals. Treatment of acute leukemia should be started as early as possible, although in the case of chronic leukemia, with slow progression of the disease and good health, therapy may be delayed.
There are several treatments for leukemia.
- Chemotherapy is the use of special drugs that destroy leukemic cells or prevent them from dividing.
- Radiation therapy – destruction of leukemic cells using ionizing radiation.
- Biological therapy – the use of drugs that work similarly to specific proteins produced by the immune system to fight cancer.
- Bone marrow transplant – The patient is transplanted with normal bone marrow cells from a suitable donor. First, a course of chemotherapy or radiation therapy in high doses is carried out in order to destroy all abnormal cells in the body.
The prognosis of the disease depends on the type of leukemia. In acute lymphoblastic leukemia, more than 95% of patients are cured, in acute myeloid leukemia – about 75%. In chronic leukemia, the prognosis is influenced by the stage of the disease at which treatment is started. This type of leukemia progresses slowly, and the average life expectancy of patients is 10-20 years.
There is no specific prophylaxis of leukemia. For the timely diagnosis of the disease, it is necessary to regularly undergo preventive medical examinations.
- Complete blood count
- Leukocyte formula
- Cytological examination of punctates, scrapings of other organs and tissues
Acute lymphoblastic leukemia (ALL) in children and adolescents
Three phases of treatment
ALL treatment includes 3 phases and lasts from 2 to 3 years. The main treatment for ALL is chemotherapy. Chemotherapy uses powerful drugs to stop the growth of tumor cells by destroying them or preventing them from dividing.Children are most often prescribed a combination of different drugs. These drugs can be injected into the bloodstream (intravenously), taken by mouth (orally), or injected directly into the cerebrospinal fluid (intrathecally).
The choice of chemotherapy method and drugs depends on the child’s risk group. Children with high-risk leukemia usually receive more anticancer drugs and / or higher doses than children with low-risk ALL.
The goal of induction therapy is to destroy blast cells in the blood and bone marrow and bring the disease into remission.This phase usually lasts 4-6 weeks. At the same time, central nervous system (CNS) conservative therapy (also called prophylactic CNS therapy) may be given to destroy the blast cells remaining in the cerebrospinal fluid. In this case, drugs are injected into the fluid-filled space between the thin layers of tissue covering the spinal cord (intrathecally).
A combination of chemotherapy drugs is used for treatment. These drugs may include vincristine, steroids, and pegaspargase or asparaginase Erwinia , sometimes with an anthracycline drug such as doxorubicin or daunorubicin.Some protocols use a treatment regimen during induction therapy that includes cyclophosphamide, cytarabine, and 6-mercaptopurine.
2. Consolidation / intensification phase
The goal of consolidation / intensification therapy is to kill any remaining cells capable of growth and causing recurrence of leukemia. This phase usually lasts 8-16 weeks.
The patient is prescribed various drugs such as cyclophosphamide, cytarabine and or 6-mercaptopurine (6-MP).Methotrexate may also be given with or without leucovorin-protected therapy.
3. Stabilization / continuation phase
The goal of maintenance therapy, the last and longest phase, is to kill any tumor cells that might survive the first 2 phases. The stabilization phase can last 2 or 3 years.
This phase may include the use of drugs such as methotrexate, vincristine, steroids, 6-mercaptopurine (6-MP).Anthracycline drugs, cyclophosphamide, and cytarabine may be given to high-risk patients.
City Clinical Hospital №31 – Help Patients. Hematological diseases. Part V. Acute leukemia (page 3)
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Acute lymphoblastic leukemia / lymphoma
Acute lymphoblastic leukemia / lymphoma (ALL) is a neoplastic blood disease in which rapidly multiplying lymphoid blast cells appear.(We already talked about blast cells in the chapter “Acute leukemia”.)
Symptoms of acute lymphoblastic leukemia are very diverse. Often the patient complains of weakness, night sweats, “aches” throughout the body, severe headache; there are other complaints as well. During the examination, the doctor discovers that the patient may have an enlarged liver, spleen, lymph nodes and there are tumor blast cells in the blood test.
To make a diagnosis, a blood or bone marrow test called “blast flow cytometry” must be done.If the patient has enlarged lymph nodes, then in order to make a diagnosis, a fragment of it is taken for morphological and immunohistochemical studies. If the disease is manifested only by an increase in lymph nodes, then doctors call this condition “ lymphoblastic lymphoma “. If tumor cells are found in the patient’s bone marrow, the diagnosis is “ acute lymphoblastic leukemia “. When a morphologist issues a conclusion on the results of a lymph node examination, he sometimes writes the diagnosis through a slash, indicating both diseases.This is permissible because the prognosis and treatment for these diseases are the same. A more accurate diagnosis is made by the attending physician based on the entire completeness of the patient’s analyzes.
In medical documents, when recording a diagnosis, doctors indicate from which cells a given leukemia originates (B- or T-cell). The diagnosis “ leukemia ” is very serious in itself, but the extremely important signs predicting the course of the disease are genetic breakdowns in tumor cells. They are observed and described by cytogenetic doctors during the cytogenetic study.
Lymphoblastic leukemias are treated with chemotherapy. It can be divided into 3 stages: induction, consolidation and support. The induction stage should result in a complete response (complete remission), that is, we can say that the patient has become “temporarily healthy”. This means that the overwhelming majority of tumor cells have died, the patient’s well-being has improved significantly, but only a few “dormant” tumor cells remain, so the treatment must be continued. If a complete answer is reached, then the next stage is called “consolidation”, or consolidation of the achieved result.As a rule, the patient tolerates consolidating or “fixing” chemotherapy better, although it consists of large doses of chemotherapy. In the future, individual patients undergo several courses of supportive therapy in order to destroy the remaining tumor cells with small doses of chemotherapy. Although chemotherapy usually works well in the early stages and most patients achieve a complete response, some patients return to disease and relapse.If the risk of recurrence is high, then to avoid it, young patients undergo blood stem cell transplants. It should be noted that when blood stem cell transplant centers were opened in large cities of Russia, the treatment results of our patients improved significantly. They have become the same as in hematology centers in North America and Europe.
Leukemia | UNIM Blog
Leukemia (leukemia) is a malignant neoplasm resulting from the formation in the bone marrow of a very large number of abnormal immature cells – blasts.Leukemia is a heterogeneous group of diseases, depending on the type of leukemia, the prognosis, treatment and its duration can vary significantly.
The causes of leukemia are not fully understood, they differ in different types of the disease. It is possible to distinguish the effect of ionizing radiation, chemotherapy for malignant neoplasms in the past, the effect of some viruses (human T-lymphotropic virus is associated with the development of some types of adult T-cell leukemia), some chemical carcinogens (for example, oil products).There are genetic disorders in which the risk of leukemia is higher (for example, Down syndrome, Fanconi anemia,)
Acute and chronic leukemia are distinguished. Acute leukemia is characterized by a rapid increase in the number of blasts that form in the bone marrow and spread through the body with the blood. Acute leukemia is the most common type of leukemia in children. Depending on the source of blast cells, acute leukemias are divided into lymphoblastic (developing from precursor cells of lymphocytes) and myeloblastic (from the precursors of other hematopoietic cells: erythrocytes, other types of leukocytes, platelets).
Chronic leukemia is accompanied by excessive formation of a large number of mature abnormal cells in the bone marrow. The disease can last for a long time, and after years it can progress with the development of a blast crisis. Chronic leukemia is also subdivided into lymphocytic and myelocytic leukemia.
This is a simplified scheme for the classification of leukemia, since there are more complex subdivisions depending on the maturity of blasts, molecular genetic characteristics.
The general symptoms of leukemia are associated with damage to the bone marrow and a decrease in the amount of blood corpuscles: anemia, which is accompanied by fatigue, weakness, pallor, a decrease in the number of platelets leads to bleeding, the appearance of small-spotted and punctate hemorrhages on the skin.Fever, swollen lymph nodes, bone pain, nausea, headaches, and abdominal pain are also noted.
Clinical examination for leukemia includes blood tests (including general, biochemical, coagulogram, immunogram), bone marrow punctate examination with cytochemical examination, immunophenotyping, cytogenetic research, molecular biological research. Also shown are lumbar puncture, X-ray of the chest cavity organs in 2 projections, CT or MRI of the brain, MRI of the skeleton, ultrasound of the abdominal cavity and testicles.Electrocardiography and ultrasound of the heart are mandatory.
The basis of leukemia treatment is chemotherapy. The combination of drugs and the duration of treatment differ significantly for different types of disease, therapy is carried out in accordance with the protocols and recommendations. In some cases, additional radiation therapy is required. Bone marrow transplantation is also used to treat many types of leukemia.
90,000 What is leukemia, what are the symptoms and complications of this disease
- Causes of leukemia
- How does leukemia manifest
- Forms and varieties of acute leukemia
- Chronic leukemia
- Diagnostics and treatment
Leukemia is a disease of the hematopoietic system.This pathology is otherwise called leukemia, leukemia, blood cancer.
Leukemia is a type of hemoblastosis – a malignant tumor disease that affects the hematopoietic and lymphatic tissues.
Statistics show a steady increase in leukemia over the past decades. This trend is worldwide. In many countries of the world, hemoblastosis ranks 5-6 in the ranking of oncological diseases.
Studies have shown that both adults and children are prone to leukemia.Leukemia is diagnosed more often in men than in women. Most of the patients are residents of large cities. The disease occurs in early childhood. As a rule, acute lymphoblastic leukemia is diagnosed in preschoolers and young people. In middle-aged and mature patients, chronic myeloid leukemia is more often found.
Causes of leukemia
Research is still underway in the world, the results of which could shed light on the mechanisms of development of blood cancer. Currently, experts declare several factors that can trigger the development of the disease.It:
- radiation, excessive insolation;
- exposure to chemical compounds that have a mutagenic effect;
- chromosomal defects;
- metabolic disorders.
At risk are people who live in a radioactive contamination zone or undergo radiation therapy. Malignant transformation of blood cells can be caused by benzene, drugs with a cytostatic effect.An increased likelihood of leukemia is observed in patients with Down’s disease, Louis-Bar syndrome. Some types of hematological malignancies are caused by exposure to retroviruses and improper assimilation of tryptophan.
How does leukemia manifest
With leukemia, the formation of blood cells is disrupted. Normal leukocyte cells are replaced by pathologically altered cells that cannot perform their functions. Diseased cells live longer than healthy cells, but at the same time they do not mature to the end and divide uncontrollably, increasing their population.With leukemia, normal leukocytes are displaced, a decrease in the number of platelets and erythrocytes is noted. Because of this, the work of the hematopoietic system is disrupted.
Leukemia affects the bone marrow, lymph nodes, spleen, liver, and causes negative changes in the nervous system. In patients with hemoblastosis, anemia develops, a tendency to bleeding appears, and immunity decreases due to a deficiency of healthy white blood cells. For such people, any infectious diseases pose an increased danger.Due to the low resistance of the body, the disease can lead to serious complications, including death.
Tumor cells from the bone marrow begin to spread throughout the body, causing disturbances in the functioning of organs and tissues. First of all, the lymph nodes are affected, which increase in size. When cancer cells enter the liver and spleen, they cause hyperplasia – an increase in size. With the penetration of leukemic cells into the meninges, various disturbances in the work of the central nervous system are observed.The patient complains of a headache, he may experience vomiting, paralysis of the optic and facial nerves. In people of mature age, shortness of breath and disturbances in the work of the heart often occur.
At the initial stages, leukemia is manifested by signs of general intoxication:
- an increase in temperature, which is kept at 38-39 C ° for a long period of time;
- weakness and fatigue;
- an increase in lymph nodes, especially cervical, axillary and inguinal;
- enlargement of the liver and spleen;
- abdominal pain, lack of appetite.
90,027 small bruises on the skin;
One of the specific signs of the disease is subcutaneous hemorrhage. They arise from a deficiency of platelets, which are responsible for blood clotting. Bruises and bruises can be seen not only on the skin, but also on the mucous membranes, which are eroded and bleed. Leukemia damages the oral mucosa. The patient develops gingivitis, stomatitis, ulcerative changes in the tonsils. Subcutaneous hemorrhages can be very small, punctate.This phenomenon is called petechiae.
Due to an increase in the volume of the bone marrow, ossalgia and arthralgia develop – pain in the bones and joints. The pain covers the whole body or specific areas. In some cases, it becomes so strong that the patient is forced to limit mobility.
Such symptoms are typical for numerous diseases, so the patient cannot always associate his condition with such a serious pathology as leukemia.Many people postpone the visit to the doctor and thus delay the start of treatment.
Forms and varieties of acute leukemia
Leukemia is acute and chronic. According to statistics, up to 60% of diagnosed cases are acute leukemia. It is most often found in childhood and young age. This disease is characterized by rapid onset of symptoms and progression. The bone marrow stops releasing normal cells, which causes pronounced changes in blood counts.
Depending on the type of affected cells, the disease is of three types:
With lymphoblastic leukemia, the lymphoid line of hematopoiesis is damaged. The tumor consists of lymphoblasts, which are the precursors of lymphocytes. Up to 85% of such diseases are diagnosed in children 2-5 years old.
In the myeloblastic form, myeloblasts and other blast cells are affected.In an undifferentiated form of acute leukemia, the tumor consists of progenitor cells without signs of differentiation.
Each form has several subtypes, which differ in symptoms, changes at the cellular and molecular levels, and sensitivity to therapy. Depending on which variant of leukemia is diagnosed in the patient, an appropriate treatment protocol is selected.
This form of the disease is most often diagnosed in adults, most often after many of them have been exposed to ionizing radiation.Chronic leukemia develops over several years. The tumor consists of mature cells that, due to changes, are unable to perform their functions and continue to divide uncontrollably. As in acute leukemia, there are lymphocytic and myelocytic forms of the disease.
A type of chronic leukemia is erythremia. The disease affects red blood cells, accompanied by neutrophilic leukocytosis and thrombocytosis.
Chronic leukemia is characterized by slow or moderate progression.The disease can develop over 4-6 or 8-12 years. Deterioration of the condition occurs when abnormally altered cells leave the bone marrow and metastasize in different organs.
Against the background of chronic leukemia, the patient has severe exhaustion, inflammation of the lymph nodes, and pustular skin lesions. Internal bleeding and hemorrhage in vital organs are especially dangerous. It is these complications, along with purulent-septic lesions, that most often lead to death.
Diagnostics and treatment
If there are signs of leukemia, you should consult a therapist or pediatrician. The doctor will prescribe general and biochemical blood tests to determine possible changes. If leukemia is suspected, the patient is admitted to the Oncology and Hematology Department for additional examinations.
First of all, this is a bone marrow analysis, which will confirm or deny the diagnosis. If confirmed, bone marrow puncture data can determine the type of disease.
To assess the degree of damage to other organs, the patient undergoes a lumbar puncture to examine the cerebrospinal fluid, ultrasound of internal organs, MRI, and X-ray. Survey data are needed to assess the scale of the disease and draw up a treatment plan.
Complex therapy of leukemia includes the following procedures:
- Chemotherapy. This is the main way to fight leukemia cells. The treatment protocol is selected depending on the form of the disease.It is a standardized program that involves the use of drugs and combinations to kill diseased cells and block their growth. Chemotherapy is given in courses that vary in duration and intensity. Treatment can be carried out on the basis of a medical institution or on an outpatient basis.
- Radiation therapy. In some cases, if the disease has affected the spinal cord and brain, radiation may be prescribed to the patient.
- Bone marrow transplant.Combining high-dose chemotherapy with bone marrow transplant is part of many treatment protocols. The task of the operation is to restore the hematopoietic function of the bone marrow after the destruction of leukemic cells.
Leukemia is a disease that can manifest itself with relapses. Their likelihood depends on the type of leukemia, its progression, timeliness of diagnosis, and response to treatment. In recent years, specialists have managed to significantly improve the situation in this area thanks to the use of modern techniques and drugs.Typically, relapses occur within the first two to three years after diagnosis. In this case, the likelihood of an unfavorable prognosis increases.
If the patient has lived five years without relapse, we can talk about a stable remission.
ACUTE LYMPHOBLASTIC LEUKEMIA ASSOCIATED WITH CORONAVIRAL INTERSTITIAL PNEUMONITIS
Purpose of the study . Demonstrate one of the clinical cases of acute lymphoblastic leukemia (ALL) associated with acute coronavirus interstitial pneumonitis (IPP).
Materials and methods. A 43-year-old patient with ALL associated with acute coronavirus interstitial pneumonitis (AIP) was examined.
Results. ALL associated with RIP of coronavirus etiology was accompanied by hyperthermia, dry cough, shortness of breath, lack of charm and taste, progressive weakness, severe headache, palpitations, pain in the tubular bones, bleeding from the gums, abdominal pain, nausea and vomiting, vomiting malaise.In the patient’s peripheral blood, lymphocytopenia was found, an increase in the amount of D-dimer by 5 times, ferritin by 6 times, CRP concentration by 3 times. There was a decrease in the degree of blood saturation (oxygen saturation) – 91% up to acute respiratory failure. Computed tomography of the lungs revealed areas of reduced transparency of the parenchyma by the type of “ground glass”. There was a decrease in the degree of blood saturation (saturation) O2-83% up to acute respiratory failure.
Conclusions. In a patient with a severe course of coronavirus infection with a burdened somatic history, an increase in D-dimer and ferritin was observed due to the development of a “cytokine storm”. The appearance of signs of overload of the right ventricle, revealed during echocardiography in a patient, and a drop in blood pressure, can be considered a sufficient basis for the diagnosis of pulmonary embolism and thrombolysis. Early detection and timely prevention of clinical manifestations of thrombotic complications prevents severe complications and mortality.
Keywords : acute lymphoblastic leukemia, acute interstitial coronavirus pneumonitis, cytokine storm, D – dimer, ferritin, saturation.
Relevance. Acute lymphoblastic leukemia (ALL) is a malignant disease of the hematopoietic system, consisting in the appearance of a tumor clone from cells – hematopoietic precursors of lymphoid differentiation lines, with the involvement of various organs and systems of the body, as well as the likelihood of damage to the lymphatic system without the involvement of the bone marrow [4, 7 , nine].
More than 60% of acute lymphoblastic leukemia occurs in children (under 10 years of age) than in adults. The peak incidence is between 3 and 5 years of age; the second peak is observed at the age of 50-60 years [6, 8].
Foreign literature describes that African Americans are 2 times less likely to get ALL than the white population of America. Hispanic populations have a higher incidence of ALL than other ethnic populations [3, 7].
In the Russian Federation, in 2014, ALL was diagnosed in 1,731 patients, half of whom are under 18 years of age.
Risk factors for the development of ALL are most often associated with radiation exposure and the use of radiotherapy .
Patients with ALL complain of progressive weakness, sweating, bone and abdominal pain, arthralgia, bleeding gums, headache, nausea, vomiting, and swollen lymph nodes. An objective examination reveals pallor of the skin, hemorrhagic rashes, soreness when beating bones, enlargement of the liver, spleen and lymph nodes.In peripheral blood analysis, blast cells appear [1, 2].
Many researchers point to a possible link between ALL and infectious diseases. The virus that causes ALL is not yet known. Reliable information on the existence of a link between leukemia and viral diseases was obtained only for T-cell leukemias in adult patients living in Asian countries .
The immunodeficiency state in ALL is manifested by the addition of a secondary infection (bacterial, viral and fungal).The coexistence of a new strain of coronavirus (SARS-CoV-2) with leukemia leads to an extremely severe course of the disease, accompanied by increasing respiratory failure, which in most cases is fatal [1, 5].
According to the academician of the Russian Academy of Sciences, professor Chuchalin A.G., with covid acute interstitial pneumonitis (OIP), the walls of the alveoli are affected, chemical pneumonitis develops, hyaluronic acid is poured into the space of the alveoli and oxygen starvation develops, to which the vessels respond with spasms and blood clots.The virus infects the membrane, that is, the membrane of the alveoli, which leads to the outpouring of hyaluronic acid from them – this is how the phenomenon of “ground glass” is formed – an increase in the density of lung tissue. As a result of damage to the walls of the alveoli by coronavirus, vasospasm, thrombus formation, hypoxia, interstitial edema develop; on computed tomography of the lungs, areas of reduced transparency of the parenchyma appear as “ground glass” .
Purpose of the study. Demonstrate one of the clinical cases of acute lymphoblastic leukemia associated with acute coronavirus interstitial pneumonitis.
Patient H., born in 1976, a resident of the Khatlon region. For the first time, the patient in September 2019 felt progressive weakness, severe headaches, palpitations, pain in the tubular bones, bleeding from the gums. Accompanied by relatives, they turned to the Research Institute of Hematology of the Russian Federation, where the diagnosis was confirmed: acute lymphoblastic leukemia. Received induction cytostatic therapy according to the Helzer program. And with this diagnosis, the patient was hospitalized and was discharged with complete clinical and hematological remission.Subsequently, she received 2 courses of consolidation therapy, re-induction, 2 courses of late consolidation therapy. From February 2019 to the present day she received supportive cytostatic therapy. Clinical and hematological parameters and myelogram results before each course of PCT were within normal limits. After discharge from the hospital, the patient was under the supervision of a hematologist. In April 2020, the body temperature increased to 40 ° C, dry cough, shortness of breath, sore throat, lack of charm and taste, pain all over the body, and malaise worried.The patient was in close contact with a sick mother suffering from severe coronavirus pneumonitis. She was treated without permission, took aspirin, ceftrioxone. Despite the therapy, the general condition worsened day after day. A month later, there were abdominal pains, nausea, vomiting and diarrhea. The patient late, after 1 month, in a serious condition, turned to an infectious disease specialist and a hematologist with secondary complications.
I went to the family doctor. In addition to the generally accepted clinical and laboratory research methods, PCR diagnostics were carried out in human genetic material (from the nasopharynx, mouth and throat) and an express test for antibodies to CJVID (IgG and IgM), hemostasis study, D – dimer, ferritin, CT of the lungs, ECG, D-EchoCG, determination of the degree of blood oxygen saturation (pulse oximetry).
Computed tomography (CT) of the lungs revealed areas of reduced transparency of the parenchyma by the “ground glass” type (Fig. 1). Based on clinical and laboratory data, lung CT scan results, PCR diagnostics in human genetic material (positive test), the diagnosis was made: acute lymphoblastic leukemia associated with acute coronavirus interstitial pneumonitis. Cytokine storm.
The general condition on examination is severe.Consciousness is clear. It is oriented in space and time. The position is horizontal.
Visible mucous membranes and skin are pale, hemorrhages on the skin of the abdomen, upper and lower extremities. Axillary lymph nodes are enlarged, pea-sized, painless. The chest is asthenic. Breathing through the nose is free. The boundaries of the lungs are within normal limits. On auscultation, against the background of weakening of vesicular respiration, crepitant rales were heard in the lower lobes of both lungs.BH 27 per minute. The borders of the heart are expanded. Auscultatory heart sounds are muffled, rhythmic. HELL 90/60 mm Hg Pulse 108 beats per minute. Tongue – pale pink, dry, overlaid with white bloom. The abdomen is slightly swollen, the liver protrudes from under the edge of the costal arch by 3.5 cm, the spleen is palpable, of dense consistency. The tapping symptom is negative on both sides.
In the general analysis of blood (04/17/2020): erythrocytes – 3.77; hemoglobin – 103.0; color – 0.9; stab – 8; segmented – 30; eosinophils – 3; lymphocytes – 11; monocytes – 3, ESR – 47 mm.Hg
In the biochemical analysis of blood from 04/18/2020: total protein 60.2 g / l; total bilirubin 15.1 μmol / l; direct bilirubin – 5.0 μmol / l; indirect bilirubin – 10 μmol / l; ALAT 18.1; urea – 8.7.
Lymphocytopenia, an increase in the amount of D-dimer by 5 times, ferritin by 6 times, and the concentration of CRP by 3 times, were found in the peripheral blood of a patient with a severe course of IUP. There was a decrease in the degree of blood saturation (oxygen saturation) – 91% up to acute respiratory failure.Thrombotic complications were indirectly manifested in the form of severe shortness of breath, cyanosis of the skin, pain in the heart and in the lumbar region, and urinary disorders. Echocardiography revealed a dysfunction of the right ventricle, signs of cardiomegaly, possibly associated with the addition of acute myocarditis.
The patient was examined by an infectious disease specialist, hematologist and pulmonologist. She was prescribed an antibiotic of the fluoroquinol series, antiretroviral corticosteroid and anticoagulant therapy, antiplatelet agents, oxygen therapy.To avoid immunosuppressive complications, PCT was temporarily canceled.
After the therapy on the 10th day, the clinical, laboratory and instrumental parameters improved.
Thus, in a patient with ALL, with a somatic history, an increase in the level of D-dimer and ferritin was observed, due to the development of a “cytokine storm”. The appearance of signs of overload of the right ventricle, identified during echocardiography in a patient, and a drop in blood pressure can be considered a sufficient basis for the diagnosis of PE and thrombolysis.Early detection and timely prevention of clinical manifestations of thrombotic complications prevents severe complications and mortality.
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Information about authors
1. Mustafakulova Namuna Ibragimovna – Head.Department of Internal Medicine №3 GOU “TSMU named after Abuali ibn Sino “, Doctor of Medical Sciences, Professor; tel .: (+992) 918762494; e-mail: [email protected]
2. Rakhmatov Mukim Karimovich – Hematologist of the consultative polyclinic of the State Institution NMC RT “Shifobakhsh”, Ph.D.
3. Makhmadaliev Firdavs Nasimovich – post-graduate student of the Department of Internal Diseases No. 3 of the State Educational Institution “TSMU named after Abuali ibni Sino “.
4. Kholova Shakhnoza Kudratovna – Doctor of PhD, Department of Internal Medicine №3, State Educational Institution “TSMU named after Abuali ibn Sino ”
Mustafakulova N.I., Rakhmatov M.K., Makhmadaliev F.N., Kholova Sh.K.,
Department of Internal Medicine No. 3
“Masks” of leukemia – GBUZRK “Republican Children’s Clinical Hospital”
How do you suspect a child is seriously ill?
In the modern world, the problem of malignant neoplasms is under close public scrutiny.Especially when it comes to children. The relevance of the study of acute leukemia in children is high, despite a fairly high level of understanding of the nature of the disease. Thanks to modern approaches to the diagnosis and treatment of acute leukemia, today it is possible to fight this deadly disease.
But how can one suspect that a child is suffering from a serious illness? What should be alarming, what are the “first bells” requiring an urgent visit to a doctor? After all, the problem of leukemia can affect everyone, regardless of social and material status.However, it should be remembered that the lifestyle of the parents affects the health of the child, including the risk of developing leukemia.
Let’s start with what is leukemia? Acute leukemia (leukemia) is a systemic malignant disease of hematopoietic tissue, the morphological substrate of which is immature blast cells that affect the bone marrow, displacing normal cellular elements and spreading not only through the hematopoietic organs, but also to other organs and systems, including lymphatic nodes, spleen, liver, testicles, central nervous system.In other words, the affected bone marrow produces cells called blasts, which do not mature, multiply rapidly, and do not obey the body’s regulatory systems. A large number of blasts accumulate in the bone marrow, they interfere with normal cells being produced and performing their natural functions. Then blasts leave the bone marrow into the bloodstream and spread throughout the body, accumulating in organs and systems, thereby disrupting their functions. Blast cells are like a crowd of rebels who riot on a ship that is a human body, occupy all the premises and establish their own rules, their own authority, preventing the captain and staff from leading the ship.True, the blasts are not able to control the body, since they are not trained to do this, and soon the ship called “life” begins to sink …
There are signs to watch out for. The peak incidence occurs at the age of 2 to 5 years, with a gradual decrease in the number of cases by 7 years and older. However, there are cases of congenital leukemia, when the first symptoms can appear within a few days, weeks after birth. You can get sick with leukemia in adolescence and young age.The symptoms of this disease are nonspecific, some signs, unfortunately, are often not taken seriously, especially in the early stages of the development of the disease. You should know that leukemia develops gradually, the first symptoms may appear after 1.5-2 months from the onset of the disease. During this period, the child may have changes in behavior, he began to eat poorly, lose weight, quickly and often get tired, sweat, especially at night. The child may have a decline in school performance, may lose interest in favorite activities, in communication with peers.When leukemic cells begin to leave the bone marrow into the blood and accumulate in organs and tissues, changes occur that make us pay attention to themselves. At this stage, leukemia begins to “hide its true face.” The variety of symptoms and the absence of specific manifestations make it difficult to diagnose the disease, and the fact that there is multiple organ damage, allows leukemia to disguise itself as various diseases. In this regard, the so-called “masks” of leukemia are distinguished. There are the main syndromes characteristic of acute leukemia: hyperplastic (infiltration of organs and tissues with tumor cells), intoxication (fever, pain syndrome, lethargy, sweating), hemorrhagic (various types of hemorrhage), anemic (suppression of the red sprout of hematopoiesis, anemia of varying severity) , immunodeficiency (a decrease in the level of neutrophils, which is manifested by the development of infectious processes).Children with leukemia develop frequent colds, infectious diseases, accompanied by intoxication syndrome, which is manifested by pain in the joints and bones, in the abdomen, in the throat, in the ears, and headaches. The child may be bothered by fever, cough, runny nose, he becomes lethargic, pale. All this hides leukemia under the “mask” of ARVI, pneumonia, bronchitis, tonsillitis, mononucleosis, parotitis, otitis media, tonsillitis and even appendicitis. The infectious process, as a faithful companion of leukemia, reliably hides it behind itself.Often, such patients receive treatment in an infectious diseases hospital, ENT department, pulmonology, surgery, or are on outpatient treatment under the supervision of a local pediatrician. Children with severe stomatitis and recurrent gingivitis are often treated by a dentist. So the immunodeficiency and hyperplastic syndrome of acute leukemia tries to “hide”. Abdominal pain, enlargement of the liver and spleen, jaundice, various kinds of dyspeptic symptoms force the parents to take the child to a gastroenterologist.In this case, leukemia “puts on a mask” of hepatitis, cholecystitis and other diseases of the gastrointestinal tract. Symptoms such as headaches, memory loss, mood swings, vomiting, impaired coordination of movements are symptoms of damage to the nervous system (neuroleukemia). These patients can be treated by a neurologist. And, as a rule, such treatment is ineffective or brings a slight improvement in the patient’s condition, followed by an increasing decompensation of the functions of organs and systems. In the meantime, precious time is lost until the correct diagnosis is made and the start of specific therapy.Leukemic infiltrates (leukemides – an accumulation of tumor cells in the skin and organs) can be confused with neoplasms of a different genesis, for which children undergo surgical treatment. Especially important is the defeat of the testicles, when the infiltrate is confused with a neoplasm of the testicle and orchiectomy (removal of the testicle) is performed. Also, with leukemia, there are tumors of the anterior mediastinum, the severity and clinical manifestations of which depend on the volume and location of the formation. The most dangerous is the development of a compression syndrome with the formation of respiratory failure, a violation of cardiac activity, requiring an immediate start of therapy.Therefore, it is important to differentiate them with lymphomas, lymphosarcomas, lymphogranulomatosis, because the child’s life will depend on the correctly started treatment. There are cases when the disease manifests itself with damage to the skeletal system. Such children were observed by orthopedic traumatologists. Of course, there are cases of asymptomatic course of the first acute period, when the child’s well-being is satisfactory, without any complaints. There may be a slight increase in peripheral lymph nodes, liver, spleen.The diagnosis in this case can be established by chance by examining the analysis of peripheral blood.
The enlargement of peripheral lymph nodes is a separate issue in this problem. Difficulties are associated with the fact that often children diagnosed with lymphadenitis are observed by surgeons and pediatricians and receive physiotherapy procedures in the form of warming compresses. This therapy is contraindicated in malignant processes. And it turns out that leukemia is not just trying to “hide” from us under the guise of other diseases, it is trying to lead the parents and the doctor on the “wrong track”, forcing them to make mistake after mistake, while aggravating the child’s condition.
All of the above delays the process of establishing the only correct diagnosis, misleads, often creates conflict situations between parents and medical workers, since the child receives treatment, but recovery does not occur. Sometimes, from the appearance of the first symptoms to an appointment with a hematologist, the patient overcomes a long and difficult path from several weeks to several months.
Another variant of the manifestation of acute leukemia is bone marrow failure.This is most often the reason for patients seeking medical help. The difference is that the child almost immediately falls into the hands of a hematologist and the period of time before the diagnosis is significantly reduced. What worries parents more often? Pallor of the skin, weakness, drowsiness, fatigue, shortness of breath, heart palpitations are signs of anemia. And the deeper the anemia, the more pronounced the symptoms. Anemia can be both an independent disease and a symptom of acute leukemia.Hence, it follows that acute leukemia can hide behind the “mask” of anemia. The next group of symptoms together make up the hemorrhagic syndrome. It is caused by a decrease in the number of platelets, an increase in permeability and a decrease in the resistance of the vascular wall, a deficiency of coagulation factors. It is manifested by hemorrhages in the skin and mucous membranes, nasal, gastrointestinal, renal, pulmonary, uterine, cerebral bleeding, which can be profuse and threaten the patient’s life.Small-point elements appear on the child’s skin, more often on the lower extremities, in places of friction, in severe cases on the head and mucous membranes. The child may also develop bruises all over the body, without prior trauma. Like anemia, thrombocytopenia can be an isolated disease, and leukemia can also be “masked” behind it. The presence of an infectious process in a child may indicate a decrease in the number of neutrophils, which are designed to protect our body. In the study of peripheral blood, the most characteristic of acute leukemia are: anemia, leukocytosis (rarely leukopenia or normal leukocyte count), thrombocytopenia, the presence of blast cells.These signs are an indication for hospitalization in the hematology department, further examination and treatment.
Thus, from the above, the following conclusions can be drawn:
- Acute leukemia in children is a serious, dangerous and insidious disease that should not be underestimated.
- Acute leukemia as a criminal hides his face under a mask.
- Not only a pediatrician, but also a doctor of any narrow specialty can meet with the debut of acute leukemia.
- The symptoms of leukemia are nonspecific and their appearance does not necessarily hide a terrible disease. However, if the child’s treatment is delayed and does not bring the desired effect, the lymphoproliferative process should be excluded from the circle of differential diagnosis.
- The presence of cancer vigilance among doctors of any specialty is a guarantee of timely diagnosis and initiation of treatment.
- Careful observation by parents of their child’s health, timely seeking medical help, trusting the attending physician and providing full information improves the prognosis of the course of the disease.
- The diagnosis of acute leukemia is made “under a microscope”, so a lot depends on the qualifications and experience of the clinical laboratory workers.
- Acute leukemia in children is currently not a fatal disease. Thanks to modern diagnostic methods, the introduction of the latest treatment methods, state support for patients with leukemia, and the help of charitable organizations, in recent years it has been possible to make a huge step in the fight against this serious ailment.
Head of Department
Oncology and Hematology
with Chemotherapy, Chief
Freelance Hematology Children’s Ministry of Health of the Republic of Kazakhstan
Hematologist, pediatric department
Oncology and hematology with chemotherapy