|AYAs should be referred immediately to a specialist if they have unexplained petechiae or hepatosplenomegaly.||C|
The presence of one or more of the following symptoms and signs requires consideration of investigation with FBC and blood film:
Symptoms and signs
Leukaemia usually presents with a relatively short history of weeks rather than months in adolescents and young adults (AYAs). It is typically indicated by hepatomegaly, splenomegaly, petechiae, purpura, mucosal bleeding and palpable lymphadenopathy (for acute lymphoid leukaemia (ALL)). Pallor, fatigue, fever, persistent or unexplained bone pain (for ALL) and abnormal bleeding or bruising (for acute myeloid leukaemia (AML)) are all symptoms. Other possible symptoms include irritability, upper respiratory tract infections, headache and anorexia.
AYAs presenting with unexplained petechiae or hepatosplenomegaly should be referred to a specialist immediately.
General practitioners (GPs) should initiate investigations with FBC and blood film in AYAs presenting with other key symptoms and signs (pallor, fatigue, unexplained irritability, unexplained fever, persistent or recurrent upper respiratory tract infections, generalised lymphadenopathy, persistent or unexplained bone pain or unexplained bruising). If the FBC or blood film indicates leukaemia then an urgent specialist referral should be made.
Risk factors for leukaemia are known to include genetic disorders such as Down Syndrome, neurofibromatosis, Fanconi syndrome and Bloom syndrome as well as ionising radiation in utero. Individuals with Down syndrome have nearly a 20-fold increased risk of leukaemia.
AML has been associated with chemotherapy and ALL with therapeutic post-natal ionising radiation and higher socio-economic status.
However, leukaemia can occur in AYAs without any of these risk factors.
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