Signs and symptoms

Leukemia is cancer of the blood-forming tissues that make up the bone marrow
inside large bones. The diseased bone marrow floods the body with abnormal white
cells. These cells do not perform the infection-fighting functions of healthy, mature
white cells. In addition, production of red cells, which carry oxygen, and platelets,
which help prevent bleeding, is decreased. Chapter 2, Leukemia, provides an in-depth
explanation of the various leukemias, their causes and treatments.
Parents are usually the first to notice that something is wrong with their child. Occa-
sionally, a pediatrician notices a problem during a well-baby visit, or the disease is
discovered by chance on a routine blood test. Unfortunately, some of the signs and
symptoms of leukemia mimic common childhood illnesses, sometimes making diag-
nosis difficult.
The onset of the disease can be slow and insidious or very rapid. Initially, children
begin to tire easily and rest often. Frequently, they have a fever which comes and
goes. Interest in eating gradually diminishes, but only some children lose weight.
Parents usually notice pale skin and occasional bruising. Some children develop
back, leg, and joint pain which makes it difficult for them to walk. Often lymph
nodes in the neck or groin become enlarged, and the upper abdomen protrudes due
to enlargement of the spleen and liver. Children become cranky and irritable, and
occasional nosebleeds develop.
Usually parents have an uneasy feeling that something is wrong, but cannot pinpoint
the cause for their concern.
Preston (10 years old) had an incredible diagnosis. We were very lucky.
We were at our beach cabin for Thanksgiving. Preston was tired and
listless and had a low-grade fever (99–100º) that had persisted for
several days. We were bringing his younger sister into town to attend a
birthday party, so we decided to bring Preston in to have him checked by
the pediatrician on call. The doctor asked Preston what was wrong, and
he said, “I don’t know, I just feel awful.” The doctor ordered blood work
and a chest x-ray, and within thirty minutes I was told that he had a
“blood cancer.” I wanted to take Preston back to the cabin, but was told
we needed to go immediately to the hospital, where Preston was admitted,
and treatment began.
Most parents react to their concerns by taking their child to a doctor, as Preston’s
parents did. Usually, the doctor performs a physical exam and frequently orders
blood work, including a complete blood count (CBC). Sometimes the diagnosis is
not so easy or fast as Preston’s.
I had been worried about Christine (3 years old) for two weeks. She
was pale and tired. She ate nothing but toast, and had developed bruises
on her shins. At preschool, she was unusually irritable, and would utter
a high-pitched scream whenever upset. She told me that she didn’t want
to go to preschool anymore, and when I asked why, she said, “It’s just too
much for me, Mommy.”
I took her to the doctor on an afternoon when he was very busy. He
measured Christine’s weight and height, pronounced them normal, and
described her lack of appetite as “nothing to worry about.” I told him that
all she was doing was lying on the couch and asked why she would have
bruises on her legs. He said bruises on shins always take a long time to
heal. When I pointed out how pale she was, he stated that all children are
pale in the winter.
I grew more and more concerned and took her back the next week. The
doctor discovered an ear infection and prescribed antibiotics. I asked why
her eyelids were puffy and he thought it was from sinuses. When I told
him of Christine’s withdrawal from preschool, he suggested that I read
a book entitled “The Difficult Child.”
Things continued to deteriorate, and I called three days later to say
that she seemed to be sicker. Her prescription for antibiotics was changed
without the doctor seeing her. I was starting to feel frantic, and went to
talk to my neighbor who had recently retired after forty years of nursing.
I told her I was afraid Christine had leukemia, and I cried. She said I
should take her back to the doctor and insist on blood work. When I took
her in that afternoon, her white count was over 200,000 (normal is
10,000, the rest were cancer cells) and her hematocrit (percentage of
oxygen-carrying red cells) was 12, far lower than the normal 36.