Acute leukaemia often presents rapidly with clinical features of pancytopenia due to bone marrow failure such as fatigue, pallor, bruising, bleeding and infections which can be particularly severe. Due to extramedullary leukaemic infiltration there can be lymphadenopathy and/or hepatosplenomegaly.
Chronic myeloid leukaemia (CML) usually develops gradually and in the early chronic phase people are often asymptomatic. CML can progress to a more accelerated phase with symptoms arising from the accumulation of abnormal cells in the bone marrow and blood. Clinical features include, anaemia, low platelets, repeated infections, splenomegaly, drenching sweats and weight loss.
Chronic lymphocytic leukaemia (CLL) is an indolent haematological cancer that can be an incidental finding on a blood test or less commonly present with lymphadenopathy, splenomegaly, symptoms of associated cytopenia (breathlessness, fatigue, petechiae, infections) or B symptoms (weight loss, fever, or drenching night sweats).
Consider urgent clinical assessment, including full blood count (FBC), of an adult patient with any of the following unexplained features:
- Pallor
- Bleeding, bruising or petechial haemorrhage
- Fatigue
- Breathlessness
- Recurrent infections
- Fever
- Drenching night sweats
- Lymphadenopathy (lymph node 2cm or more in size, persisting for six weeks or more, or increasing in size, or generalised lymphadenopathy)
- Hepatomegaly and/or splenomegaly.
Further referral advice can then be followed based on findings – please see the individual FBC abnormalities on RefHelp and the lymphadenopathy page.
NS & CM 5/3/26
EMERGENCY SAME DAY REFERRAL – please phone haematology on call:
- Blood count/film reported as suggestive of Acute Leukaemia or Chronic Myeloid Leukaemia (CML)
Refer to haematology as Urgent Suspicious of Cancer:
A Lymphocyte count >5 x 109 /l and any of the following features:
- weight loss, fever, or drenching night sweats.
- lymphadenopathy and/or splenomegaly.
- cytopenia (haemoglobin less than 100 g/l, neutrophils less than 1.0 x 109 /l, platelets less than 100 x 109 /l).
