Acute lymphoblastic leukemia (ALL) is a rapidly progressing type of leukemia. Individuals with this disease may show no symptoms one week, with completely normal blood counts, yet within a week experience both disrupted blood counts and sudden onset of symptoms. Therefore, attention should be paid to certain symptoms.

The most common symptoms of acute lymphoblastic leukemia include:

**Sudden onset weakness and fatigue:** This is caused by leukemia cells invading the bone marrow, disrupting blood production and reducing red blood cell count. The decrease in red blood cells leads to a decrease in hemoglobin, the protein that carries oxygen to organs. Low hemoglobin levels can cause weakness, fatigue, shortness of breath during walking, palpitations, and lethargy.

**Bleeding:** Leukemia cells invading the bone marrow reduce the production of platelets (thrombocytes), cells responsible for blood clotting, leading to a bleeding tendency. This can manifest as bruising, gum bleeding, nosebleeds, and other types of bleeding.

**Fever, Infection/Inflammation:** Leukemia cells invading the bone marrow disrupt the production and reduce the number of leukocytes (white blood cells), the body's defense cells. This disruption can lead to infection development. Depending on the location of the infection, symptoms may include fever, sore throat, cough, runny nose, postnasal drip, and soft tissue inflammation. Fever can also occur in ALL without any infection, solely due to the leukemia.

Acute lymphoblastic leukemia, like other acute leukemias, begins in the bone marrow but often rapidly spreads to the blood. It can sometimes spread to other parts of the body, including lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testicles. In these cases, symptoms may arise depending on the affected organ. It is important to remember that the presence of one or more of the following symptoms does not diagnose acute leukemia. The presence of blood count abnormalities must also be considered. The following symptoms may be associated with ALL:

**Cough, hiccups:** These may occur due to the spread of the disease to the lungs or enlargement of lymph nodes in the chest.

**Shortness of breath:** This can occur due to the spread of the disease to the lungs, enlargement of lymph nodes in the chest, low blood counts, or lung infection.

**Enlarged liver, spleen, or lymph nodes:** This can be caused by leukemia cells leaving the bone marrow and invading these organs via the blood or lymph.

**Headache, dizziness, balance problems, back pain, lethargy:** These can be caused by the spread of leukemia cells to the nervous system, primarily the brain and spinal cord.

**Joint and bone pain:** Leukemia cells invading the bone marrow can cause various types of bone pain.

**Genital swelling:** Testicular involvement can be observed, especially in male patients, presenting as painless swelling.

**Abdominal pain, constipation, nausea, vomiting:** Acute leukemias rarely spread to the gastrointestinal system, causing these symptoms.