Clinical Presentation Symptoms Patients with AML most often present with nonspecific symptoms that begin gradually or abruptly and are the consequence of anemia, leukocytosis, leukopenia or leukocyte dysfunction, or thrombocytopenia. Nearly half have had symptoms for ≤3 months before the leukemia was diagnosed. Half mention fatigue as the first symptom, but most complain of fatigue or weakness at the time of diagnosis. Anorexia and weight loss are common. Fever with or without an identifiable infection is the initial symptom in ~10% of patients. Signs of abnormal hemostasis (bleeding, easy bruising) are noted first in 5% of patients. On occasion, bone pain, lymphadenopathy,. | Chapter 104. Acute and Chronic Myeloid Leukemia Part 4 Clinical Presentation Symptoms Patients with AML most often present with nonspecific symptoms that begin gradually or abruptly and are the consequence of anemia leukocytosis leukopenia or leukocyte dysfunction or thrombocytopenia. Nearly half have had symptoms for 3 months before the leukemia was diagnosed. Half mention fatigue as the first symptom but most complain of fatigue or weakness at the time of diagnosis. Anorexia and weight loss are common. Fever with or without an identifiable infection is the initial symptom in 10 of patients. Signs of abnormal hemostasis bleeding easy bruising are noted first in 5 of patients. On occasion bone pain lymphadenopathy nonspecific cough headache or diaphoresis is the presenting symptom. Rarely patients may present with symptoms from a mass lesion located in the soft tissues breast uterus ovary cranial or spinal dura gastrointestinal tract lung mediastinum prostate bone or other organs. The mass lesion represents a tumor of leukemic cells and is called a granulocytic sarcoma or chloroma. Typical AML may occur simultaneously later or not at all in these patients. This rare presentation is more common in patients with t 8 21 . Physical Findings Fever splenomegaly hepatomegaly lymphadenopathy sternal tenderness and evidence of infection and hemorrhage are often found at diagnosis. Significant gastrointestinal bleeding intrapulmonary hemorrhage or intracranial hemorrhage occur most often in APL. Bleeding associated with coagulopathy may also occur in monocytic AML and with extreme degrees of leukocytosis or thrombocytopenia in other morphologic subtypes. Retinal hemorrhages are detected in 15 of patients. Infiltration of the gingivae skin soft tissues or the meninges with leukemic blasts at diagnosis is characteristic of the monocytic subtypes and those with 11q23 chromosomal abnormalities. Hematologic Findings Anemia is usually present at diagnosis and can be severe. The .
