Leukemia bruises hurt

Symptoms: What are the symptoms of acute lymphoblastic leukemia?

Author: Maria Yiallouros, last changed: 08.11.2018

The symptoms (symptom e) associated with acute lymphoblastic leukemia (ALL) usually develop within a few weeks. They are due to the spread of the malignant cells in the bone marrow and other body organs and tissues. The uninhibited division of the leukemia cells in the bone marrow increasingly impairs the production of normal blood cells.

Children and adolescents who suffer from ALL are therefore initially noticed by general symptoms such as fatigue, reluctance to play and paleness (anemia). These are due to the lack of red blood cells, whose job it is to transport oxygen into the body's cells. Due to the lack of functional white blood cells (for example lymphocytes and granulocytes), pathogens can no longer be fought adequately; infections develop, which are noticeable in the form of a fever. The lack of platelets, which normally help the blood to clot quickly, can lead to bleeding from the skin and mucous membranes (see also chapter "Structure and function of bone marrow and blood").

The excess of leukemia cells in the body leads, apart from changes in the blood count, to organ problems: The growth of leukemia cells in the cavities of the bones, in the bone marrow, can cause bone pain, especially in the arms and legs. They can be so pronounced that smaller children no longer want to walk and want to be carried.

The malignant cells can also establish themselves in the liver, spleen and lymph nodes, so that these organs swell and lead to corresponding complaints, for example abdominal pain. In principle, no organ is spared. The meninges can also be affected in patients with ALL. Headaches, facial paralysis, visual disturbances and / or vomiting can result.

The following table shows symptoms that can occur with ALL, frequency information in percent according to Miller DR [MIL1990].



Fatigue, general exhaustion and listlessness, feeling sick

Very often

Pale skin due to lack of red blood cells (anemia)

in about 80% of patients


in about 60% of patients

Increased susceptibility to infection


Swollen lymph nodes, for example in the neck, in the armpits or in the groin

in about 63% of patients

Abdominal pain and loss of appetite (due to enlarged spleen and / or liver)

in about 60% of patients

Bleeding tendency with little or no external influence, for example difficult-to-stop bleeding from the nose and / or gums, bruises or small punctiform skin bleeding (petechiae)

in about 48% of patients

Bone and joint pain

in about 23% of patients

Headache, visual disturbances, vomiting, cranial nerve paralysis (due to involvement of the central nervous system)

in about 3% of patients

Shortness of breath (due to enlargement of the thymus gland or lymph nodes in the chest)

in about 7% of patients

Enlargement of the testicles

very rare


The symptoms of ALL can be very different from one individual to the next or differently pronounced. Some patients have hardly any symptoms, and the leukemia is discovered accidentally during a routine blood test.

On the other hand, the appearance of one or more of these symptoms does not necessarily mean that leukemia is present. Many of these symptoms also occur in comparatively harmless diseases that have nothing to do with leukemia. However, in the event of complaints, it is advisable to consult a doctor as soon as possible to clarify the cause. If acute leukemia is actually present, therapy must be started as soon as possible.

Symptoms of relapse

Information about possible symptoms in the event of a relapse can be found in our relapse chapter here