Clinical features of AML

Presentation of AML is usually with signs and symptoms caused by leukemic infiltration of the bone marrow and extramedullary sites (1):

• signs and symptoms of pancytopenia
  • anaemia - fatigue, exertional dyspnoea, palpitations, angina or claudication
  • thrombocytopenia - epistaxis, gingival haemorrhage, menorrhagia, cutaneous petechiae or occasionally significant gastrointestinal ,urinary or intracranial haemorrhage
  • neutropaenia
    
    
• infections which are usually bacterial or fungal and common sites for sepsis include the teeth and oropharynx, sinuses, lung, skin, perineum and bowel
  
  
• fever - presenting feature in around 15-20% of patients
  
  
• disseminated intravascular coagulation - although seen at presentation of all AML subtypes, it is much more common in childhood acute promyelocytic leukaemia (APL)
  
  
• infiltration of extramedullary sites can present as:
  • lymphadenopathy
  • hepatosplenomegaly
  • in CNS - involvement at diagnosis is seen in 15% of patients and usually manifests as leptomeningeal disease with headache and isolated cranial nerve palsies (especially V and VII), and intracranial masses
  • in skin (leukaemia cutis) - occurs in about 10% of cases
  • gingival infiltration
  • testicular involvement - rarely
    
    
• features of hyperviscosity such as dyspnoea, hypoxia, respiratory failure, headache seizures, confusion, coma visual disturbances or priapism due to leucostasis is seen in patients who present with a blast count >50×109/l

Reference:

• 1. Rubnitz JE, Gibson B, Smith FO. Acute myeloid leukemia. Pediatr Clin North Am. 2008;55(1):21-51
• 2. Smith M et al. Adult acute myeloid leukaemia. Crit Rev Oncol Hematol. 2004;50(3):197-222.