Signs are observed by parents or doctors (e.g., pale skin) and symptoms are experienced by patients (e.g., bone pain). The most common signs and symptoms of AML are:

• Fever
• Infection
• Night sweats
• Paleness
• Weakness or feeling tired
• Shortness of breath
• Headaches
• Easy bruising or bleeding (can occur internally)
• Small red spots on the skin (called petechiae) caused by bleeding
• Pain in the bones or joints
• Pain or feeling of fullness below the ribs from an enlarged spleen
• Swollen lymph nodes
• Painful sores on skin of the arms, neck, face, and back
• Painless purple lumps (called leukemia cutis) in the neck, underarm, stomach, groin, or other parts of the body

My 5-year-old son Aidan said his stomach hurt. It got so bad he was crying and couldn’t stand. We went to the ER and he was treated for constipation. Then he had a nosebleed and started getting bruises (black, scary looking ones) all over his body. I knew something was wrong. I took him to the pediatrician who drew blood and then called two hours later to tell us to go to the children’s hospital. My husband was due back from deployment overseas the next day, so my sister went with Aidan, me, and my 5-month-old daughter to the hospital. They admitted Aidan to do tests. The next morning, my sister took the baby to meet her dad for the first time, and later that day we learned Aidan had AML or APL. It was the greatest day (husband home and meeting his daughter for the first time) and the worst day (son diagnosed with cancer) of our lives.

Children with AML are sometimes diagnosed after developing a chloroma—a tumor formed from clumps of cancer cells. These pale green tumors are most often found under the skin near the eyes but may occur any place in the body.

It started six days before my daughter’s fourth birthday in July. She was restless all night and in the morning said her leg hurt. We brought her to the pediatrician. He x-rayed it and said to give her Tylenol® for a week because he thought it was a soft tissue injury. After a few days the pain went away. Throughout the months of August and September, she would occasionally wake with pain in her arm or leg. In early October, she said her shoulder hurt, the doctor x-rayed it, and said it was probably growing pains. I requested blood work because I knew something was wrong. We were told, other than her sed rate being high, all else looked normal. By mid-October, she had severe leg pain again and started to limp and she didn’t want to do things that she used to enjoy. I insisted on a referral, and we were sent to a pediatric rheumatologist (but we couldn’t get an appointment until the next month). I started to feel like we were going to lose our little girl. The pains seemed to come more often and with a greater severity so we said we needed an earlier appointment with the rheumatologist. After the appointment and lots of tests, the rheumatologist called to say, “Her white count has dropped severely so I’m sending you to a hematologist/oncologist. I don’t know what it is but there is something brewing.” We were given an appointment with the hematologist/oncologist the next day. Over the next two weeks, we were in daily for blood work, x-rays, a CT scan, a bone scan, an MRI, and finally a bone marrow aspiration. The day following the bone marrow aspiration, November 12, the pediatric oncologist called to say that she had AML, and to come to the hospital immediately prepared for a long stay. The bottom fell out of our world.

Approximately 20% of children with AML have WBC counts above 100,000 μL at diagnosis. This huge number of cancerous cells in the blood can result in the following symptoms:

• Rapid and/or difficult breathing
• Fluid in the lungs
• Headache
• Sleepiness
• Confusion
• Seizures

About 10 to 13% of children with AML have the disease in their CNS at diagnosis, but few of these children have symptoms of CNS disease, such as seizures, vomiting, blurred vision, or difficulty maintaining balance.