Leukemia

Leukemia is a cancer of the blood-forming (haematopoietic) cells of the bone marrow. Instead of producing healthy blood cells, the marrow makes large numbers of abnormal cells, usually white cells, which build up and crowd out normal production of red cells, healthy white cells and platelets. It comes in acute forms (which develop quickly over days to weeks and need prompt treatment) and chronic forms (which develop slowly and may be found on a routine blood test before causing symptoms), and in lymphoid and myeloid types depending on the cell of origin. Because normal blood production is squeezed out, the symptoms often reflect what is missing: tiredness, pallor and breathlessness from anaemia; frequent or severe infections from a shortage of healthy white cells; and easy bruising, nosebleeds or bleeding gums from low platelets. Some people also have bone pain, night sweats, weight loss, or swelling from an enlarged spleen or lymph nodes. A full blood count is usually the first clue — showing abnormal white cell numbers, anaemia and a low platelet count — and the diagnosis is confirmed by examining the blood and bone marrow. Outcomes vary widely by type, but many leukemias are treatable, and some are curable.

• White cell count (WBC) — often abnormal: very high, very low, or with abnormal cell types seen on the blood film.
• Haemoglobin — often low (anaemia), causing tiredness and pallor.
• Platelets — often low, causing easy bruising and bleeding.
• LDH and uric acid — often raised, reflecting high cell turnover.
• A blood film and bone-marrow examination — confirm the diagnosis and type.
• Kidney and liver function — assessed before and during treatment.

• Persistent tiredness, pallor and breathlessness (from anaemia)
• Frequent, severe or slow-to-heal infections
• Easy bruising, nosebleeds or bleeding gums (from low platelets)
• Fevers and drenching night sweats
• Bone or joint pain
• Unintended weight loss
• Swelling from an enlarged spleen or lymph nodes