Summary

Acute leukaemia is a cancer of the blood and bone marrow where immature blood cells (blasts) multiply rapidly and crowd out normal blood cells. Think of your bone marrow as a factory that makes blood cells—in acute leukaemia, the factory starts making too many immature, non-functional cells (blasts) that can't do their job, while normal blood cells (red cells, white cells, platelets) can't be made properly. This leads to three main problems: anemia (not enough red cells—fatigue, breathlessness), infection (not enough normal white cells—fever, infections), and bleeding (not enough platelets—bruising, bleeding). There are two main types: acute myeloid leukaemia (AML—affects myeloid cells) and acute lymphoblastic leukaemia (ALL—affects lymphoid cells, more common in children). Acute leukaemia is a medical emergency that requires urgent treatment. The key to management is recognizing the condition (symptoms of anemia, infection, bleeding, sometimes organ infiltration), confirming the diagnosis (blood tests showing blasts, bone marrow biopsy), classifying the type and subtype (essential for treatment), and urgent chemotherapy (induction chemotherapy to achieve remission, then consolidation/maintenance). Early recognition and prompt treatment are essential—delayed treatment significantly increases mortality.

Key Facts

• Definition: Cancer of blood and bone marrow with rapid multiplication of immature blood cells
• Incidence: Rare (3-5 per 100,000 per year)
• Mortality: High (30-50% overall, varies by type and age)
• Peak age: Bimodal (children for ALL, older adults for AML)
• Critical feature: Anemia, infection, bleeding, blasts in blood/bone marrow
• Key investigation: Blood tests (FBC showing blasts), bone marrow biopsy
• First-line treatment: Urgent chemotherapy (induction)

Clinical Pearls

"Think of it with pancytopenia" — If a patient has pancytopenia (low red cells, white cells, platelets) with blasts in the blood, think acute leukaemia. Don't miss this.

"Fever + pancytopenia = infection until proven otherwise, but also think leukaemia" — Fever with low blood counts can be infection (neutropenic sepsis), but can also be the presenting feature of leukaemia. Check for blasts.

"Bone marrow biopsy is essential" — Blood tests may show blasts, but bone marrow biopsy is essential to confirm, classify the type, and guide treatment. Don't skip this.

"Time matters" — Acute leukaemia is a medical emergency. Once diagnosed, treatment should start urgently (usually within days). Delayed treatment increases mortality.

Why This Matters Clinically

Acute leukaemia is a life-threatening condition that requires urgent recognition and treatment. Early recognition (especially pancytopenia with blasts), prompt diagnosis (bone marrow biopsy), and urgent chemotherapy are essential. This is a condition that haematologists and oncologists manage, and prompt treatment can be life-saving.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: May have respiratory distress (anemia, infection, hyperleukocytosis)
• Listen: May have crackles (infection)
• Measure: SpO2 (may be low)
• Action: Support if needed

C - Circulation

• Look: Signs of anemia, bleeding
• Feel: Pulse (may be fast), BP (usually normal)
• Listen: Heart sounds (may have flow murmur if anemia)
• Measure: BP (usually normal), HR (may be fast)
• Action: Monitor if severe

D - Disability

• Assessment: May have neurological symptoms (if CNS involvement or hyperleukocytosis)
• Action: Assess if severe

E - Exposure

• Look: Full examination, look for bruising, organ enlargement
• Feel: Liver, spleen, lymph nodes
• Action: Complete examination

Specific Examination Findings

Hematological Examination:

• Pallor: Anemia
• Bruising: Thrombocytopenia
• Petechiae: Thrombocytopenia
• Active bleeding: If severe

Organ Examination:

• Hepatosplenomegaly: Organ infiltration
• Lymphadenopathy: Organ infiltration
• Gum hypertrophy: Organ infiltration (AML)
• CNS: May have signs if CNS involved (ALL)

Special Tests

Natural History (Without Treatment)

Untreated Acute Leukaemia:

• High mortality: 90-100% mortality within months
• Poor outcomes: If not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Young age: Better outcomes
• Good genetics: Better outcomes
• Early treatment: Better outcomes
• Good response: Better outcomes

Poor Prognosis:

• Older age: Worse outcomes
• Poor genetics: Worse outcomes
• Delayed treatment: Worse outcomes
• Poor response: Worse outcomes

Prognostic Factors

Key Guidelines

1. NICE Guidelines (2016) — Leukaemia: diagnosis and management. National Institute for Health and Care Excellence

Key Recommendations:

• Urgent diagnosis
• Urgent chemotherapy
• Evidence Level: 1A

Landmark Trials

Multiple studies on chemotherapy regimens, outcomes.

Evidence Strength

What is Acute Leukaemia?

Acute leukaemia is a cancer of the blood and bone marrow where immature blood cells multiply rapidly and crowd out normal blood cells. Think of your bone marrow as a factory that makes blood cells—in acute leukaemia, the factory starts making too many immature, non-functional cells that can't do their job, while normal blood cells can't be made properly.

In simple terms: Your bone marrow is making too many bad blood cells and not enough good ones. This causes anemia (not enough red cells), infection (not enough normal white cells), and bleeding (not enough platelets). This is serious and needs urgent treatment.

Why does it matter?

Acute leukaemia is a life-threatening condition that requires urgent treatment. Early recognition and prompt chemotherapy are essential. The good news? With proper treatment, many people achieve remission, and some are cured.

Think of it like this: It's like your blood cell factory making too many bad cells—it needs urgent treatment to stop this and start making good cells again.

How is it treated?

1. Diagnosis:

• Blood tests: You'll have blood tests that show abnormal cells
• Bone marrow test: You'll have a test of your bone marrow to confirm and see what type
• Why: To confirm the diagnosis and plan treatment

2. Treat Complications (Urgent):

• Infection: If you have a fever or infection, you'll get antibiotics urgently
• Bleeding: If you're bleeding, you'll get platelets to help your blood clot
• Anemia: If you're very anemic, you'll get a blood transfusion
• Why: To support your body while the leukaemia is treated

3. Chemotherapy (Urgent):

• What: You'll get strong medicines (chemotherapy) to kill the leukaemia cells
• When: Usually starts within days of diagnosis
• Why: To kill the leukaemia cells and allow your bone marrow to make normal cells again
• Duration: Usually several months of treatment

4. Supportive Care:

• Infection prevention: You'll get medicines and precautions to prevent infection
• Blood products: You'll get blood products (platelets, red cells) as needed
• Monitoring: Close monitoring for complications

The goal: Kill the leukaemia cells, allow your bone marrow to make normal cells again, and achieve remission (disease under control) or cure.

What to expect

Recovery:

• Treatment: Usually starts within days
• Hospital stay: Usually weeks to months (for chemotherapy)
• Remission: Most people achieve remission (disease under control) within weeks to months
• Cure: Some people are cured (30-50%), but this varies

After Treatment:

• Monitoring: Regular monitoring to check if the disease stays in remission
• Relapse: Some people may have a relapse (disease returns), which can be treated
• Long-term: Ongoing management, may need further treatment

Recovery Time:

• Remission: Usually within weeks to months
• Long-term: Ongoing management

When to seek help

Call 999 (or your emergency number) immediately if:

• You have a fever and feel very unwell
• You're bleeding heavily
• You feel very unwell
• You have symptoms that concern you

See your doctor if:

• You have unexplained fatigue, bruising, or infections
• You have symptoms that concern you
• You have a known diagnosis of leukaemia and develop new symptoms

Remember: If you have unexplained fatigue, bruising, or infections, especially if you have a fever, see your doctor. Acute leukaemia is serious, but with prompt treatment, many people achieve remission. Don't delay—if you're worried, seek help immediately.