Clinical features

• Acute presentation usual; often critically ill due to effects of bone marrow failure.

• Symptoms of anaemia: weakness, lethargy, breathlessness, lightheaded-ness and palpitations.

• Infection: particularly chest, mouth, perianal, skin (Staphylococcus, Pseudomonas, HSV, Candida). Fever, malaise, sweats.

• Haemorrhage (especially M3 due to DIC): purpura, menorrhagia and epistaxis, bleeding gums, rectal, retina.

• Gum hypertrophy and skin infiltration (M4, M5).

• Signs of leucostasis e.g. hypoxia, retinal haemorrhage, confusion or diffuse pulmonary shadowing.

• Hepatomegaly occurs in 20%, splenomegaly in 24%; the latter should raise the question of transformed CML; lymphadenopathy is infrequent (17%)

• CNS involvement at presentation is rare in adults with AML.

1 Grimwade, D. et at (2001) The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood, 98, 1312-1320 2 Smith, M.A. et at. (1996) The secondary leukemias: challenges and research directions. J Natl Cancer Inst, 88, 407-418.

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