What are the early symptoms of chronic leukemia in children?

Generally, chronic leukemia in children is primarily chronic myeloid leukemia (CML), with common symptoms including unexplained fatigue and decreased appetite, abdominal masses, mild bleeding tendencies, recurrent low-grade fever, and bone or muscle aches. A detailed analysis is as follows:

1. Unexplained fatigue and decreased appetite

This is a common early non-specific symptom caused by the high metabolic activity of leukemia cells consuming nutrients or mild anemia leading to insufficient tissue oxygenation. Children may show reduced exercise tolerance (e.g., easily tiring after running or jumping), lethargy, and loss of appetite. No evidence of gastrointestinal disease is present, and symptoms do not significantly improve with rest.

2. Abdominal mass

In the early stages of chronic myeloid leukemia, leukemia cells often infiltrate the spleen. Parents may incidentally feel a firm mass in the child’s left upper abdomen, accompanied by mild bloating or discomfort. Because splenomegaly develops slowly, severe abdominal pain is uncommon early on; instead, bloating may worsen with physical activity. Ultrasound can confirm splenomegaly.

3. Mild bleeding tendency

Due to platelet dysfunction, children may experience intermittent nosebleeds, slight gum bleeding when brushing teeth, or small petechiae (less than 2 mm in diameter) after minor skin trauma. There is no severe bleeding such as hematemesis or melena. These signs are often mistaken for "heatiness" or minor injuries.

4. Recurrent low-grade fever

This is typically a "tumor-related fever" caused by pyrogenic factors released by leukemia cells. Body temperature fluctuates between 37.5°C and 38.5°C, without chills or symptoms of infection such as sore throat. Antibiotic treatment is ineffective, and the fever persists for 1–2 weeks at a time, recurring repeatedly.

5. Bone and muscle pain

Mild infiltration of bone marrow or periosteum by leukemia cells causes children to complain of aching pain in the knees, hips, or lower back. Pain worsens with activity and improves with rest. There is no joint redness, swelling, or history of trauma. It may be misdiagnosed as growing pains, but the pain lasts longer than typical growth-related discomfort.

The early symptoms of childhood chronic leukemia are often atypical and can be easily confused with common colds or growing pains. If a child exhibits any of the above symptoms lasting more than two weeks, parents should seek medical evaluation promptly. Diagnosis can be confirmed through complete blood count and bone marrow aspiration. Early intervention significantly improves prognosis.