# Leukaemia - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Acute Lymphocytic Leukemia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459149/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD25.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Leukaemia - disease-level clinical article (leukaemia-full.txt) - Leukaemia - disease-level clinical article (leukaemia-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text LEUKAEMIA Sources: Acute Lymphocytic Leukemia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459149/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD25.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Leukaemia - disease-level clinical article (leukaemia-full.txt), Leukaemia - disease-level clinical article (leukaemia-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Fever, tiredness, and a bleeding tendency are typical early acute leukaemia complaints [bleeding tendency · fatigue · fever] - Anaemia can cause breathlessness, and a low platelet count causes easy bruising or excess bleeding [anaemia · bleeding · breathlessness · bruising] - Acute promyelocytic leukaemia can present with gum bleeding, nosebleeds, or heavy menstrual bleeding from a coagulation disorder [abnormal uterine bleeding · gum bleeding · heavy periods · nosebleed] - Many chronic leukaemia patients have no symptoms and are found only from an incidentally raised white count on routine bloodwork - None of the symptoms is specific: fever, fatigue, weight loss, then bone pain, bruising or bleeding [bleeding · bone pain · bruising · fatigue · fever · weight loss] - Acute lymphoblastic leukaemia is the childhood one: up to 80% of leukaemias in children, against 20% of cases in adults - Chronic lymphocytic leukaemia mostly turns up between 60 and 70 years of age - Inherited risk sits with Klinefelter and Down syndromes, with Bloom syndrome, and with the telomeropathies - Fanconi anaemia, dyskeratosis congenita, Shwachman-Diamond [anaemia] - Acquired risk sits with Epstein-Barr and human T-lymphotropic virus, with ionizing radiation and radiotherapy, with benzene at work, with smoking, and with chemotherapy already given SIGNS - what you find (2) - Bone and spine pain, plus an enlarged liver/spleen and swollen nodes, can point toward acute leukaemia [hepatomegaly] - An enlarged liver, spleen, and lymph nodes can occur in chronic leukaemia too, but bruising and bleeding are less common than in the acute forms [bleeding · bruising · hepatomegaly] TESTS (7) - Initial workup is a full blood count, metabolic panel, liver tests, and clotting studies, followed by a blood film and bone marrow sampling - AML can occasionally be spotted on the smear alone by needle-like Auer rods inside the leukaemic cells - Flow cytometry, cytogenetics, and FISH are usually needed to pin down the exact subtype - Acute leukaemia usually needs a bone marrow biopsy, while chronic forms can often be diagnosed from blood alone - CML is confirmed by finding the BCR-ABL fusion protein on peripheral blood FISH testing - CLL is confirmed by a monoclonal B-cell population found on peripheral blood flow cytometry - Blasts are 1% to 5% of marrow cells normally; above 20% on the blood film or in the marrow the leukaemia is acute, below 20% it is chronic IF NOT THIS - what else fits (5) - Vitamin B12 or folate deficiency can cause similar blood count abnormalities - Copper deficiency is another mimicker of abnormal blood counts - Viral infections such as HIV, CMV, or EBV can mimic leukaemia's blood picture - Drugs such as chemotherapy agents, valproic acid, ganciclovir, or mycophenolate can alter the blood count - Autoimmune disease such as lupus is on the differential for blood count abnormalities Source StatPearls "Leukemia" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Diagnosis and treatment (chemotherapy) require urgent haematology referral; a GP recognises the pattern from a full blood count and clinical picture and refers urgently rather than prescribing. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Diagnosis and treatment (chemotherapy) require urgent haematology referral; a GP recognises the pattern from a full blood count and clinical picture and refers urgently rather than prescribing. Caution RED FLAG - Tumour lysis syndrome (hyperkalaemia, hyperuricaemia, acute renal failure): assess urgently and refer. RED FLAG - Febrile neutropenia requiring immediate broad-spectrum intravenous antibiotic coverage: assess urgently and refer. RED FLAG - Hyperleukocytosis and leukostasis syndrome (dyspnea, confusion, neurological deficits, visual changes): assess urgently and refer. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Febrile neutropenia in an immunosuppressed patient demands immediate evaluation and broad-spectrum antibiotics. RED FLAG - Disseminated Intravascular Coagulation (DIC) causes thrombosis and hemorrhage and is a severe complication of leukemia, especially APL. RED FLAG - Unexplained bruising or bleeding, pallor and fatigue, recurrent or severe infections, bone pain, hepatosplenomegaly, or a very abnormal white cell count on CBC. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)