Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records

There are four main subtypes of Leukaemia, each with a different clinical profile. Between chronic and acute subtypes, the incidence, clinical presentation, and survival all vary. Leukaemia is usually diagnosed in primary care through blood tests, either incidentally or once the disease is considered. However, none of the current UK recommendations regarding symptoms to consider investigating for the diagnosis of leukaemia were based on primary care evidence. This large case-control study included 3,814 cases and 17,025 controls. It aimed to identify the symptom profiles of chronic and acute leukaemias to help guide GPs on when to initiate blood tests for possible leukaemia. The three symptoms most strongly associated with chronic leukaemia were lymphadenopathy, weight loss, and bruising, while the three most strongly associated with acute leukaemia were nose bleeds and/or bleeding gums, fever, and fatigue. No individual symptom or combination of symptoms stands out as a high-risk marker of the disease. The results show that the symptom profiles of chronic and acute leukaemias have both overlapping and distinct features. For GPs diagnosing leukaemia by performing a full blood count is easy, however the symptoms of leukaemia are non-specific and of relatively low risk so knowing when to initiate this test may be difficult. This explains why many leukaemia diagnoses are unexpected findings. Read full text