2. Fever and infection
First, fever is one of the most common symptoms of leukemia, which can appear in different stages of recurrence, with different degrees of fever and heat type. The main cause of fever is infection, among which angina, stomatitis and perianal inflammation are the most common, and pneumonia, tonsillitis, gingivitis and perianal abscess are also very common. Ear inflammation, enteritis, carbuncle, pyelonephritis and so on. It can also be seen that sepsis and septicemia can also occur in severe infections.
B. Bacteria are the most common infectious pathogens, and Gram-positive cocci are the main pathogens in the early stage of the disease. Although virus infection is rare, it is often dangerous. Cytomegalovirus, measles or varicella virus infection is prone to pneumonia, which should be paid attention to.
3, bleeding bleeding is also a common symptom of leukemia, bleeding sites can be all over the body, with skin, gums, nasal bleeding being the most common, and retinal and ear bleeding and visceral bleeding such as intracranial, digestive tract and respiratory tract can also occur. Menstruation is also common in women and can be the first symptom. M3 and M5 subtype AML bleeding is more serious, especially M3 patients are more likely to die of disseminated intravascular coagulation (DIC) and intracranial hemorrhage.
4. Anemia can occur in the early stage, and a few cases can appear refractory anemia months or years before diagnosis, and then develop into leukemia. Patients are often accompanied by fatigue, pallor, palpitation, shortness of breath, edema of lower limbs and other symptoms. Anemia can be seen in all types of leukemia, but it is more common in elderly AML patients, and many patients often take anemia as the first symptom.
5, signs of leukemia cell infiltration
First, hepatomegaly, splenomegaly and lymphadenopathy
B, nervous system: The main pathological changes are bleeding and leukemia infiltration.
C. Bone and joint: Bone and joint pain is one of the important symptoms of leukemia, and ALL is more common.
D, skin; There are two kinds of skin lesions: specific and nonspecific. The former is characterized by maculopapules, pustules, lumps, nodules, erythroderma, exfoliative dermatitis and so on. This is more common in adult monocytic leukemia, which manifests as ecchymosis and spots on the skin.
E. oral cavity: gingival swelling, bleeding and leukemia infiltration are common in AML-M5. In severe cases, the entire gum can be extremely proliferated, swollen like a sponge, and the surface is prone to bleeding.
F. Heart: mostly manifested as myocardial leukemia infiltration, hemorrhage, epicardial hemorrhage and pericardial effusion.
G. Kidney: More than 40% leukemia patients have kidney disease.
H, gastrointestinal system: manifested as nausea and vomiting, loss of appetite, abdominal distension, diarrhea, etc.
1. Lung and pleura: It mainly infiltrates alveolar wall and lung space, but also infiltrates bronchi, pleura and blood vessel wall.
J, others: uterus, ovary, testis, prostate, etc. Can be infiltrated by white blood cells. Female patients often have vaginal bleeding and menstrual cycle disorder. Male patients may have decreased sexual desire.
diagnostic criteria
1, the clinical symptoms are sudden high fever, progressive anemia or significant bleeding, general aches and fatigue.
2, signs of skin bleeding, sternal tenderness, lymphadenopathy, hepatosplenomegaly.
3. Laboratory:
A, blood white blood cells are always significantly increased (or decreased), and primitive or naive cells may appear.
B, bone marrow-like nucleated red blood cells account for less than 50% of all nucleated cells, and the original cells are ≥30%, which can be diagnosed as acute leukemia; If the nucleated red blood cells in bone marrow are ≥50% and the proportion of primitive cells in non-erythroid cells is ≥30%, it can be diagnosed as acute erythroleukemia.
Differential diagnosis:
A, aplastic anemia;
B, myelodysplastic syndrome;
C, malignant histiocytosis;
D, idiopathic thrombocytopenic purpura