Symptoms and diagnosis of acute myeloid leukaemia (AML)

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Symptoms of AML

Many of the symptoms are caused because leukaemia can stop your body making enough normal blood cells. Symptoms vary from person to person and on the blood cells affected. Possible symptoms include:

• Tiredness (fatigue), shortness of breath, weakness, headaches, pale skin, caused by fewer red blood cells (anaemia).
• Recurrent infections or high temperatures/fever: Not enough healthy white blood cells.
• Blood in your urine, gums or stools (poo), unexplained bruising, tiny red spots on your skin: Not enough platelets in the blood.
• Serious bleeding.
• Aching bones and joints: Too many abnormal cells in your bone marrow.
• Weight loss / Loss of appetite.
• Lethargy, lack of energy.
• Enlarged lymph glands in your neck, underarm, stomach or groin.
• Enlarged spleen - poor appetite, swollen tummy or tummy pain.
• Sepsis - you may feel generally unwell, have a high or low temperature, or feel shivery.

All these symptoms can be caused by conditions other than cancer, but it’s important to go to the GP and get any unusual changes checked out. 

Can I be screened for AML?

Testing for AML when you have no symptoms is called screening. There is no leukaemia screening programme. This is because there have been no tests proven to help predict leukaemia. If you are worried about leukaemia, contact your family doctor (GP).

Diagnosing AML

Your family doctor (GP) will talk to you about your symptoms and arrange blood tests, if needed. If your blood test is abnormal you will be referred to hospital for more tests. For example:

• Physical examination: Listening to your chest, feeling your abdomen, asking questions about how you have been feeling recently.
• Blood tests, such as a full blood count.
• Lumbar puncture: Taking a sample of the fluid that surrounds your brain and spinal cord using a needle in your lower back. The fluid will be checked for cancer cells. 

If you are referred to the hospital, you might like to read more about Preparing for your hospital appointment.

Diagnosing AML with a bone marrow biopsy

• Bone marrow aspirate: A liquid sample of bone marrow cells. 
• Trephine biopsy:  A tiny sample of bone or solid marrow

The sample is examined under a microscope to see the number and type of cells in it. You may have this test to diagnose AML and also to see how you are responding to treatment.

How is a bone marrow biopsy done?

Before the test you will be given a local anaesthetic to numb the area. You will be asked to lie on your side with your knees tucked up to your chest.  A needle is passed through your skin into your bone marrow.  You will feel some discomfort during the test but it usually takes just 20–30 minutes to do.

You may be asked to lie on your back for 10–15 minutes to stop any possible bleeding. A small plaster is put on the area, which might feel tender and sore for a few days afterwards. You can take a mild painkiller for a day or two if needed. If the pain gets worse, tell the hospital.

Are there side-effects to a bone marrow biopsy?

Any side-effects are mild and should clear up quickly. For example:

• Bleeding: Where the needle goes in. If the bleeding is heavy, tell the hospital.
• Bruising: You may get a dark patch under your skin (haematoma). 
• Infection: It’s possible to get an infection where the needle goes in, but it’s rare. If the area gets red or sore or you have a temperature, let the hospital know. 

Tests on blood and bone marrow

• Chromosome studies (cytogenetics): Tests on blood or bone marrow samples that look for genetic changes in your cells. For example, sometimes with AML part of one chromosome is moved to another chromosome and a new one formed. This is called the Philadelphia chromosome and there are special treatments to target this. 
• Immunophenotyping: Checking for proteins or markers on the surface of the leukaemia cells to give more information about your type of AML. For example, the FLT3 genetic mutation has been classed higher risk in AML and can be more difficult to treat.
• You may need other tests, such as a chest x-ray or lymph gland biopsy. However, not every person requires these.