12 Warning Signs and Symptoms of Acute Myeloid Leukemia (AML)

Acute myeloid leukemia (AML) is a rapidly progressing cancer of the blood and bone marrow that affects the production of myeloid cells, a type of white blood cell. This aggressive form of leukemia can develop quickly, making early recognition of symptoms crucial for timely diagnosis and management. AML occurs when immature blood cells multiply uncontrollably, crowding out healthy blood cells and preventing the bone marrow from functioning properly.

Understanding the warning signs of AML is essential because the symptoms can often be mistaken for less serious conditions like the flu or general fatigue. The disease primarily affects adults, with the average age of diagnosis being around 68 years, though it can occur at any age. The symptoms of acute myelogenous leukemia result from the accumulation of abnormal white blood cells and the decreased production of normal blood cells, including red blood cells, platelets, and healthy white blood cells.

In this comprehensive guide, we’ll explore the twelve most common symptoms of AML, helping you recognize the early warning signs that require medical attention. If you experience several of these symptoms persistently, it’s important to consult with a healthcare professional for proper evaluation.

1. Persistent Fatigue and Weakness

One of the most common and earliest symptoms of acute myeloid leukemia is an overwhelming sense of fatigue that doesn’t improve with rest. This exhaustion occurs because AML interferes with the production of red blood cells, which are responsible for carrying oxygen throughout the body. When red blood cell counts drop, a condition called anemia develops, leaving you feeling constantly tired and weak.

This fatigue is notably different from normal tiredness. Patients often describe it as a profound exhaustion that makes even simple daily tasks feel impossible. You might find yourself needing to rest after minimal physical activity, struggling to get through a normal workday, or feeling too tired to participate in activities you previously enjoyed. The weakness may be particularly noticeable in your muscles, making climbing stairs, carrying groceries, or even standing for extended periods challenging.

The fatigue associated with AML tends to worsen over time as the disease progresses and more healthy blood cells are replaced by cancerous ones. This progressive nature helps distinguish it from temporary fatigue caused by stress, poor sleep, or viral infections.

2. Frequent or Severe Infections

People with acute myelogenous leukemia are significantly more susceptible to infections because the disease impairs the immune system’s ability to fight off bacteria, viruses, and fungi. While AML causes an overproduction of white blood cells, these cells are abnormal and immature, rendering them unable to protect the body effectively against infections.

These infections may manifest in various ways, including:

• Recurring respiratory infections such as pneumonia, bronchitis, or persistent coughs
• Frequent urinary tract infections
• Skin infections that develop easily from minor cuts or scratches
• Mouth sores or gum infections that don’t heal properly
• Sinus infections that keep returning

What makes these infections particularly concerning is that they often become severe more quickly than normal, may not respond well to standard treatments, and tend to recur even after seemingly successful treatment. You might notice that infections that would typically clear up in a few days persist for weeks, or that you’re getting sick far more frequently than usual.

3. Unexplained Fever

Fever is a frequent symptom of AML and can occur for multiple reasons. The fever may result from the leukemia itself, as the body reacts to the presence of cancerous cells, or it may indicate an infection due to the weakened immune system. Many AML patients experience recurring fevers without an obvious source of infection.

These fevers typically range from low-grade (slightly elevated temperature) to high-grade (temperatures above 101°F or 38.3°C). The fever may come and go unpredictably, sometimes appearing in the evening or at night, causing night sweats that can be severe enough to soak through clothing and bedding. Unlike fevers associated with common illnesses, these fevers may not respond well to over-the-counter fever reducers or may return quickly after the medication wears off.

If you experience persistent or recurring fevers lasting more than a few days without an identifiable cause like a cold or flu, it warrants medical investigation, especially if accompanied by other symptoms on this list.

4. Easy Bruising

Developing bruises easily and frequently is a telltale sign of acute myeloid leukemia. This symptom occurs because AML reduces the production of platelets, the blood cells responsible for clotting and preventing bleeding. When platelet counts drop below normal levels (a condition called thrombocytopenia), even minor bumps or pressure on the skin can result in bruising.

The bruises associated with AML often have distinctive characteristics:

• They appear without any remembered injury or trauma
• They may be larger than expected for the level of impact
• They can appear in unusual locations where you haven’t bumped into anything
• They take longer than normal to heal and fade
• Multiple bruises may be present at various stages of healing

You might notice bruises appearing on your arms, legs, or torso without recollection of how they got there. The bruises may range in color from red and purple when fresh to green, yellow, and brown as they heal. This easy bruising pattern is distinctly different from the occasional bruise everyone experiences and should prompt medical evaluation.

5. Unusual Bleeding

Beyond easy bruising, AML patients often experience abnormal bleeding that occurs more easily, lasts longer, or happens more frequently than normal. This bleeding tendency is directly related to the decreased platelet count that characterizes the disease. Platelets are essential for forming clots that stop bleeding, so when their numbers are insufficient, bleeding problems arise.

Common manifestations of abnormal bleeding include:

• Nosebleeds that occur spontaneously or are difficult to stop
• Bleeding gums, especially when brushing teeth or eating
• Heavy or prolonged menstrual periods in women
• Small red or purple spots on the skin called petechiae (pinpoint bleeding under the skin)
• Blood in urine or stools
• Prolonged bleeding from minor cuts or scratches

Petechiae appear as tiny red, purple, or brown dots on the skin, often on the lower legs, but can occur anywhere. They don’t blanch (turn white) when you press on them. If you notice these spots appearing in clusters or along with other bleeding symptoms, it’s important to seek medical attention promptly.

6. Bone and Joint Pain

Many individuals with acute myelogenous leukemia experience significant bone and joint pain, which occurs because the bone marrow becomes overcrowded with leukemia cells. The marrow, located inside bones, is where blood cells are produced. As cancerous cells multiply rapidly, they cause the marrow to expand, putting pressure on the bone from within and causing pain.

This pain has several characteristic features:

• It’s often described as a deep, aching sensation
• It commonly affects long bones like those in the arms and legs
• The ribs, sternum (breastbone), and pelvis may also be painful
• Pain may worsen at night or with movement
• It typically doesn’t improve with over-the-counter pain relievers

Unlike arthritis or injury-related pain that’s usually localized to joints, the bone pain from AML originates from within the bone itself. Some patients describe it as a constant, gnawing sensation, while others experience it as intermittent sharp pains. The pain may be severe enough to interfere with sleep, mobility, and daily activities.

7. Shortness of Breath

Difficulty breathing or shortness of breath (dyspnea) is a common symptom of AML that results primarily from anemia—the reduced number of red blood cells available to carry oxygen to tissues throughout the body. When your organs and muscles don’t receive adequate oxygen, your body compensates by increasing your breathing rate, leading to a feeling of breathlessness.

This symptom may manifest as:

• Feeling winded after minimal exertion, such as walking short distances or climbing a single flight of stairs
• Difficulty catching your breath during activities that previously caused no problems
• A sensation of not being able to get enough air
• Rapid breathing or feeling like you need to breathe more deeply
• Shortness of breath even at rest in more advanced cases

Additionally, in some cases, leukemia cells can accumulate in small blood vessels in the lungs, further contributing to breathing difficulties. This condition, called leukostasis, is a medical emergency requiring immediate attention. If you experience severe shortness of breath, chest pain, or confusion along with breathing difficulties, seek emergency medical care immediately.

8. Pale Skin or Pallor

A noticeably pale appearance of the skin, lips, nail beds, and inner eyelids is a visible sign of the anemia caused by acute myeloid leukemia. Red blood cells contain hemoglobin, which gives blood its red color and is responsible for oxygen transport. When red blood cell production decreases due to AML, the reduced hemoglobin levels cause the skin to lose its normal healthy color.

The pallor associated with AML may develop gradually, making it easy to miss if you see yourself daily. Others might notice the change before you do, commenting that you look pale, washed out, or unwell. The paleness is typically most noticeable in:

• The face, particularly around the cheeks and lips
• The palms of the hands
• The nail beds (the skin under and around the nails)
• The conjunctiva (the inner surface of the lower eyelid)
• The gums and inside of the mouth

In people with darker skin tones, pallor may be less obvious on the face but can still be detected by checking the nail beds, palms, or mucous membranes inside the mouth and lower eyelids. This paleness often accompanies other symptoms of anemia like fatigue and shortness of breath.

9. Swollen or Bleeding Gums

Gum problems are particularly common in acute myelogenous leukemia and can be one of the more distinctive symptoms of the disease. The gums may become swollen, tender, and prone to bleeding, sometimes significantly. This occurs for several reasons related to AML’s effects on the body.

First, the low platelet count makes gums bleed easily, even with gentle brushing or flossing. Second, the compromised immune system makes the gums more susceptible to infections. Third, in certain subtypes of AML (particularly acute monocytic leukemia), leukemia cells may directly infiltrate the gum tissue, causing noticeable swelling and enlargement called gingival hyperplasia.

Signs of gum involvement include:

• Gums that appear puffy, swollen, or enlarged
• Bleeding when brushing, flossing, or eating
• Gums that are unusually red or purple in color
• Tenderness or pain in the gums
• Gums that seem to be growing over the teeth

If you notice persistent gum problems that don’t improve with good oral hygiene or that seem disproportionate to any dental issues, especially if accompanied by other symptoms, medical evaluation is warranted.

10. Enlarged Spleen or Liver

The spleen and liver can become enlarged in people with acute myeloid leukemia as these organs accumulate leukemia cells. The spleen, located in the upper left side of the abdomen, and the liver, on the upper right side, may swell beyond their normal size as they attempt to filter the abnormal blood cells or become infiltrated with cancerous cells.

You might experience this symptom as:

• A feeling of fullness or discomfort in the upper abdomen
• Abdominal swelling or distention
• Pain or tenderness in the upper left abdomen (enlarged spleen) or upper right abdomen (enlarged liver)
• Feeling full quickly when eating, even after small amounts of food
• Discomfort that worsens when taking deep breaths

The enlarged spleen, called splenomegaly, may create a sensation of pressure or fullness on the left side of your belly. In some cases, you or your doctor may be able to feel the enlarged organ below the left rib cage. An enlarged liver (hepatomegaly) can cause similar sensations on the right side. These organs may become tender to touch, and the enlargement can contribute to overall abdominal discomfort and reduced appetite.

11. Unexplained Weight Loss

Significant weight loss without trying is a common symptom of many types of cancer, including acute myelogenous leukemia. This unintentional weight loss occurs through several mechanisms. The cancer cells consume a large amount of the body’s energy and nutrients to fuel their rapid growth. Additionally, the enlarged spleen and liver can create a feeling of fullness that reduces appetite. The overall illness and frequent infections can also decrease desire to eat.

This weight loss is characterized by:

• Losing 10 pounds or more without changes to diet or exercise
• Progressive weight loss over weeks or months
• Loss of appetite or early satiety (feeling full quickly)
• Food aversions or changes in taste
• Weight loss despite maintaining normal eating habits

Unlike intentional weight loss from dieting or lifestyle changes, this weight loss is unplanned and often accompanied by a general sense of unwellness. The loss of muscle mass and body fat can contribute to the fatigue and weakness associated with AML. If you’re experiencing unexplained weight loss along with other symptoms, it’s important to seek medical evaluation.

12. Swollen Lymph Nodes

Lymph nodes, part of the body’s immune system, can become swollen in some people with acute myeloid leukemia. While less common in AML than in some other types of leukemia, lymph node enlargement (lymphadenopathy) can occur when leukemia cells accumulate in these small, bean-shaped structures located throughout the body.

The lymph nodes most commonly affected are those that are easy to feel, including:

• Neck (cervical lymph nodes)
• Under the jaw and chin
• Armpits (axillary lymph nodes)
• Groin (inguinal lymph nodes)
• Above the collarbone (supraclavicular lymph nodes)

Swollen lymph nodes from AML typically feel like firm, painless lumps under the skin that may be pea-sized or larger. They’re usually not tender to touch, which helps distinguish them from lymph nodes swollen due to infection, which are often painful. The swelling tends to persist rather than coming and going, and the nodes may gradually increase in size. If you notice persistent swollen lymph nodes, especially if they’re accompanied by other symptoms like fever, night sweats, or fatigue, medical evaluation is necessary.

Main Causes of Acute Myeloid Leukemia

While the exact cause of acute myelogenous leukemia isn’t fully understood in most cases, researchers have identified several factors that increase the risk of developing this disease. AML occurs when DNA damage in bone marrow cells causes them to grow and divide uncontrollably, but what triggers this genetic change often remains unclear.

Genetic Mutations: Changes in specific genes, particularly those involved in cell growth and division, play a crucial role in AML development. These mutations are usually acquired during a person’s lifetime rather than inherited, though in rare cases, inherited genetic syndromes like Down syndrome, Fanconi anemia, or Li-Fraumeni syndrome increase AML risk.

Previous Cancer Treatment: People who have received chemotherapy or radiation therapy for other cancers face an elevated risk of developing AML years later. This treatment-related leukemia is particularly associated with certain chemotherapy drugs called alkylating agents and topoisomerase inhibitors.

Chemical Exposure: Long-term exposure to certain chemicals, most notably benzene (found in cigarette smoke, gasoline, and some industrial settings), significantly increases the risk of AML. Prolonged exposure to pesticides and some industrial solvents may also contribute to risk.

Blood Disorders: Pre-existing blood disorders, including myelodysplastic syndromes (MDS) and other myeloproliferative neoplasms, can progress to acute myeloid leukemia. People with these conditions require regular monitoring for signs of transformation to AML.

Age: The risk of AML increases with age, with most cases occurring in adults over 65. The disease is relatively rare in children and young adults, though it can occur at any age.

Smoking: Cigarette smoking is a confirmed risk factor for AML, likely due to exposure to benzene and other carcinogenic chemicals in tobacco smoke. Smokers have a higher risk of developing AML compared to non-smokers.

Radiation Exposure: High levels of radiation exposure, such as from atomic bomb exposure or nuclear reactor accidents, increase AML risk. Medical radiation exposure from multiple CT scans or radiation therapy also contributes to risk, though benefits typically outweigh risks.

Prevention of Acute Myeloid Leukemia

While there’s no guaranteed way to prevent acute myelogenous leukemia, particularly since many cases occur without identifiable risk factors, certain lifestyle choices and precautions can help reduce your risk of developing this disease.

Avoid Smoking: Not smoking or quitting if you currently smoke is one of the most important preventive measures. Smoking is a modifiable risk factor for AML, and eliminating tobacco use reduces exposure to benzene and other cancer-causing chemicals.

Limit Chemical Exposure: If you work in industries where exposure to benzene, pesticides, or other potentially hazardous chemicals occurs, strictly follow safety protocols. Use appropriate protective equipment, ensure adequate ventilation, and minimize direct contact with these substances. Employers should provide proper safety training and equipment.

Minimize Radiation Exposure: While medical imaging and radiation therapy are sometimes necessary and beneficial, discuss with your healthcare provider whether each test or procedure is essential. Avoid unnecessary medical radiation exposure, particularly repeated CT scans when alternative imaging methods might suffice.

Monitor Pre-existing Conditions: If you have a blood disorder like myelodysplastic syndrome or a genetic condition that increases cancer risk, work closely with your healthcare team for appropriate monitoring and management. Regular check-ups can help detect changes early.

Maintain Overall Health: While not specifically proven to prevent AML, maintaining a healthy lifestyle with a balanced diet, regular exercise, adequate sleep, and stress management supports overall health and immune function. Eating plenty of fruits, vegetables, and whole grains while limiting processed foods contributes to general wellness.

Be Aware of Family History: If you have a family history of leukemia or inherited genetic syndromes associated with increased cancer risk, inform your healthcare provider. While inherited cases are rare, awareness allows for appropriate monitoring and genetic counseling if needed.

It’s important to remember that even with these precautions, AML can still develop, as most cases occur without identifiable preventable causes. These measures reduce risk but cannot eliminate it entirely. Focus on controllable factors while maintaining regular medical check-ups for overall health monitoring.

Frequently Asked Questions

What are the first signs of acute myeloid leukemia?

The earliest signs of AML typically include persistent fatigue that doesn’t improve with rest, frequent infections, unexplained fevers, and easy bruising or unusual bleeding. Many people also notice pale skin and shortness of breath with minimal exertion. These symptoms develop because the leukemia interferes with normal blood cell production. Since these symptoms can mimic other less serious conditions, they’re often initially dismissed as flu, stress, or normal aging.

How quickly do AML symptoms develop?

Acute myeloid leukemia symptoms typically develop rapidly over days to weeks, which is why it’s called “acute.” Unlike chronic leukemias that progress slowly over months or years, AML advances quickly. Some people notice symptoms appearing suddenly within a few weeks, while others experience a more gradual onset over several weeks to a couple of months. The rapid progression is what makes early recognition and prompt medical attention so important.

Can AML symptoms come and go?

Some AML symptoms, particularly fever and infections, may seem to come and go, but the underlying condition is continuously progressing. Symptoms like fatigue, weakness, and easy bruising tend to be persistent and worsen over time rather than fluctuating. You might experience temporary improvement in symptoms like fever or infection with treatment, but they typically return. Unlike symptoms of viral illnesses that resolve completely, AML symptoms persist or progressively worsen without appropriate medical intervention.

What’s the difference between AML and other types of leukemia?

AML is an acute (rapidly progressing) leukemia affecting myeloid cells, while other types include acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). Acute leukemias progress quickly and involve immature cells, while chronic leukemias develop slowly with more mature cells. The symptoms of acute leukemias like AML tend to appear suddenly and worsen rapidly, whereas chronic leukemias may not cause symptoms for months or years.

Are AML symptoms different in older adults?

While the core symptoms of AML remain the same across age groups, older adults may experience them differently or more severely. Fatigue and weakness might be attributed to normal aging, potentially delaying diagnosis. Older adults with AML may also experience more severe infections and complications due to overall decreased immune function and other age-related health conditions. They may also have more pronounced cognitive symptoms like confusion or difficulty concentrating.

Can you have AML without symptoms?

It’s rare but possible to have very early AML without noticeable symptoms. In some cases, AML is discovered incidentally through routine blood work done for other reasons before symptoms develop. However, because AML progresses rapidly, symptom-free periods are typically short. Most people develop noticeable symptoms relatively quickly as the disease advances and normal blood cell production becomes increasingly impaired.

When should I see a doctor about possible AML symptoms?

You should see a doctor promptly if you experience persistent fatigue that doesn’t improve with rest, unexplained fevers lasting more than a few days, easy bruising or unusual bleeding, or frequent infections. Seek immediate medical attention if you have severe shortness of breath, heavy bleeding that won’t stop, signs of serious infection like high fever with chills, or confusion. Any combination of multiple symptoms listed in this article warrants medical evaluation, even if symptoms seem mild.

What tests diagnose AML?

AML diagnosis begins with blood tests, including a complete blood count (CBC) that reveals abnormal levels of white blood cells, red blood cells, and platelets. If AML is suspected, a bone marrow biopsy is performed, where a sample of bone marrow is removed and examined under a microscope for leukemia cells. Additional tests including flow cytometry, cytogenetic analysis, and molecular testing help identify the specific subtype of AML and guide treatment planning. Imaging tests like CT scans or chest X-rays may be done to check for organ involvement.

Is AML hereditary?

AML is not usually hereditary. Most cases involve genetic mutations that develop during a person’s lifetime rather than being inherited from parents. However, certain rare inherited genetic syndromes like Down syndrome, Fanconi anemia, Bloom syndrome, and Li-Fraumeni syndrome do increase the risk of developing AML. Having a close family member with AML slightly increases your risk, but this increased risk is relatively small. The vast majority of AML cases occur in people with no family history of the disease.

Does having one symptom mean I have AML?

No, experiencing one symptom doesn’t mean you have AML. Many of these symptoms are common and can result from numerous other, less serious conditions. Fatigue might be from poor sleep, anemia from other causes, or simply from stress. Fevers usually indicate common infections. However, if you experience multiple symptoms simultaneously, if symptoms persist despite treatment, or if they progressively worsen, medical evaluation is important to rule out serious conditions including AML.

References:

• American Cancer Society – Acute Myeloid Leukemia
• Mayo Clinic – Acute Myelogenous Leukemia
• National Cancer Institute – Adult Acute Myeloid Leukemia Treatment
• Leukemia & Lymphoma Society – Acute Myeloid Leukemia
• NHS – Acute Myeloid Leukaemia