Erythroleukemia Clinical Presentation

Updated: Dec 29, 2015
  • Author: Beata Holkova, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Presentation

History

At presentation, the signs and symptoms of erythroleukemia are usually nonspecific and are attributable to the decreased hematopoiesis resulting from the replacement of bone marrow by leukemic cells. This decrease results in anemia, thrombocytopenia, and leukopenia. [7]

Patients rarely present with symptoms lasting longer than 6 months, and they are usually diagnosed within 1-3 months after the onset of symptoms. The most common presenting symptoms are as follows:

  • Fatigue or malaise
  • Minimal-to-modest weight loss
  • Easy bruising
  • Fever
  • Bone or abdominal pain
  • Dyspnea
  • Meningeal signs and symptoms (very rare, only if leukemic involvement of the central nervous system [CNS] is present)
  • Diffuse joint pain (nonspecific in one third of patients)
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Physical

Physical examination findings may include the following:

  • Pallor (anemia)
  • Hemorrhage (thrombocytopenia) - Ecchymoses or petechiae; gum bleeding; epistaxis; retinal hemorrhage
  • Fever and infection (neutropenia) - Respiratory tract, urinary tract, sinuses, perirectal area, or skin
  • Hepatosplenomegaly (< 25% of cases)
  • Lymphadenopathy
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Complications

Complications may include opportunistic infections and neutropenic fever, tumor lysis syndrome (ie, hyperuricemia, hyperkalemia, hyperphosphatemia), and bleeding.

Infections, even if properly treated, may be fatal. Recognizing patients who are at risk for tumor lysis syndrome (high tumor burden, elevated uric acid) is important. Intravenous hydration and allopurinol should be started before chemotherapy, and serum electrolytes and renal function should be monitored. Patients who have received multiple platelet transfusions may become refractory. To reduce alloimmunization, single-donor platelets or human leukocyte antigen (HLA)-matched platelets with leukocyte reduction filters should be used.

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