The symptoms of leukemia usually come on suddenly within a few days or weeks. What is the first sign of leukemia? Early indicators of acute leukemia can be difficult to recognize because they often mimic the symptoms of influenza and other less serious conditions. Furthermore, with chronic myeloid or lymphocytic leukemia, the abnormal leukemia cells can function almost as well as normal white blood cells. As a result, many people who have leukemia find out when receiving routine blood work or medical care for an unrelated reason.

How does leukemia affect the body?

Leukemia is a type of cancer that affects the body’s blood-forming cells in the bone marrow and lymphatic system. The malignancy can take any of several forms and spread at different rates. Most types of leukemia interfere with the production of healthy white blood cells, which normally multiply at a controlled rate, protect the body from infection by fighting off viruses and bacteria, then die off at the conclusion of their normal lifespan. Leukemia causes white blood cells to reproduce very rapidly, live longer than they should and collect in the bloodstream, eventually crowding out healthy cells and possibly causing signs and symptoms of leukemia.

What are the signs of leukemia?

Leukemia symptoms can vary based on several unique factors, including the type of leukemia present and the person’s age and overall health. With that said, there are several common leukemia symptoms, any of which may be the first sign of leukemia. They include:

Fatigue and weakness
Pale skin
Excessive sweating, especially at night
Unintended weight loss
Fever and chills
Frequent infections
Tiny red, purple or brown spots under the skin (petechiae)
Bone pain and tenderness
Painless lumps (swollen lymph nodes) in the neck, underarm, stomach or groin
Swelling and discomfort in the midsection
Loss of appetite
Low blood cell levels (aplastic anemia)

Leukemia symptoms tend to become more frequent and severe with time. This is especially true with acute myeloid and acute lymphocytic leukemias, which tend to be faster-growing and more symptomatic than chronic leukemias.

Three leukemia symptoms you might not know

Leukemia can produce a variety of symptoms, although most are not often apparent in the earliest stages of the malignancy. The most common symptoms of leukemia—fatigue, pale skin, weight loss and night sweats—are often attributed to other less serious conditions, such as the flu.

Some of the less obvious leukemia symptoms that may accompany the more common warning signs include:

Easy bruising and bleeding (and chronic nosebleeds) due to a shortage of blood-clotting platelets
Heightened sensitivity to hot and cold temperatures due to low red blood cell counts
Tenderness just below the ribcage on the left side of the body due to liver or spleen enlargement

What are petechiae?

Many people have questions about the distinctive leukemia rash known as petechiae. What exactly are these pinpoint-sized skin spots, and how are they related to leukemia? Petechiae develop when a small blood vessel (capillary) under the skin’s surface breaks open. Normally, platelets help the blood clot and therefore would prevent blood from escaping a broken capillary. However, because leukemia lowers platelet counts, it can interfere with the blood-clotting process. Instead, blood can escape a broken capillary and rise toward the surface of the skin, forming tiny red spots.

What do leukemia spots look like?

Petechiae can be red, purple or brown and are often found on the:

Arms
Midsection
Buttocks
Legs

Petechiae from leukemia often resemble a common skin rash, such as atopic dermatitis. However, leukemia rashes have a distinguishing characteristic: When pressure is applied, the spots will retain their red, purple or brown color. Conversely, when pressure is applied to any other type of rash, the skin will turn white.

Petechiae are not exclusively a leukemia skin rash. For instance, in addition to leukemia, tiny red spots on the skin are associated with strep throat, scarlet fever, scurvy and sepsis. Additionally, petechiae can be a side effect of certain medications, such as blood thinners, sedatives and antidepressants. Finally, a leukemia-like skin rash may develop if a blood vessel in the face, neck or chest is strained and tears. This can occur during coughing, vomiting or weightlifting.

It is important to understand that petechiae do not definitively signal the presence of cancer. However, any unusual red spots on the skin should be evaluated by an experienced medical professional, especially if other leukemia symptoms are present.

What does leukemia bone pain feel like?

Many people are curious about leukemia bone pain. What does leukemia bone pain feel like? Is it similar to joint pain or a muscle ache? Does leukemia bone pain come and go? Is it easy to recognize? A key feature that distinguishes leukemia bone pain from a muscle ache is that the former tends to linger during rest, while the latter usually flares after physical activity. The nature of the discomfort can vary; some patients report sharp pain while others liken it to a dull, continuous ache.

What bones hurt with leukemia? Bone pain symptoms tend to develop in areas of the body with bones that contain a large amount of bone marrow, such as the:

Breastbone (sternum)
Arms
Ribcage
Hips
Legs

Why does leukemia cause bruising?

What is the relationship between leukemia and bruising? Because leukemia affects the body’s blood-clotting ability, easy bruising is a common symptom. Even a seemingly minor incident, such as bumping a shin against a table, can cause a bruise to form. Additionally, many people experience random bruising from leukemia that cannot be traced to a specific incident. While leukemia bruises can form anywhere on the body, they are most commonly found on the arms and legs.

What to do if you have leukemia symptoms

It is important to keep in mind that leukemia symptoms do not conclusively indicate cancer in every case. So, how do you know if you have leukemia? An experienced physician can recommend appropriate diagnostic testing and, if necessary, refer you to an oncologist for a more detailed assessment.

Leukemia diagnosis and treatment at Moffitt Cancer Center

The Malignant Hematology Program at Moffitt is home to a team of renowned oncologists who specialize in diagnosing and treating all types of leukemia and other blood and bone marrow cancers. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt is proud to have a robust clinical trials program through which our patients can benefit from groundbreaking new treatment options that are not yet available in other settings.

Medically reviewed by Leidy Isenalumhe, MD, Malignant Hematology.

If you would like to discuss your leukemia symptoms with a specialist in the Malignant Hematology Program at Moffitt Cancer Center, call 1-888-663-3488 or use our convenient new patient registration form online to request an appointment. You do not need a referral from your primary doctor. After you reach out to us, we will connect you with a cancer expert as soon as possible.