Acute promyelocytic leukemia, or APL, occurs most often in children and adults over age 40, according to St. Jude Children's Research Hospital. The disease develops when white blood cells called promyelocytes proliferate abnormally. Acute promyelocytic leukemia is a type of acute myeloid leukemia, or AML, and makes up 10 to 15 percent of AML cases, the University of California San Francisco states. Symptoms of APL are similar to those of AML, but with several notable differences.
Bleeding
Easy bleeding is the hallmark of APL, Cephalon Oncology reports. The bleeding in AML resembles disseminated intravascular clotting, or DIC, a disorder that causes clotting in small blood vessels that uses up all the clotting factor in the blood. Low platelet levels due to the proliferation of promyelocytic blood cells contribute to bleeding. Symptoms include easy bruising, excessive bleeding during menstruation and after blood draws, nosebleeds, bleeding gums and blood in the urine. Bruises may appear spontaneously and small red dots called petechiae, which represent bleeding under the skin in the smallest blood vessels, may also appear.
Fatigue
The proliferation of promyelocytes decreases production of red bloods cells in the bone marrow. A drop in red blood cells causes anemia. Red blood cells contain hemoglobin, which carries oxygen to the body and removes carbon dioxide from the blood and carries it back to the lungs to be exhaled. When red blood cell levels drop, oxygen levels decrease, and a person becomes fatigued and often short of breath on exertion. Pallor often occurs from a lack of red blood cells. Weight loss and lack of appetite may also occur.
Infection Susceptibility
Normal white blood cell production also gets crowded out by the proliferation of promyelocytes. Since white blood cells fight infection, a drop in normal white blood cells, called leukopenia, makes a person prone to infection. The total white blood count is high in APL, because promyelocytes are white blood cells, but mature granulocyte levels are low. Cuts may heal slowly.
Bone Pain
Bone pain or joint pain can occur in APL because cancer cells spread from the bone marrow to the joints or surface of the bone, a phenomenon called extramedullary spread, according to Cephalon Oncology.
