A second peak in incidence is seen in elderly patients. Only half of all patients with ALL have increased leukocytes and may not have lymphoblasts in their peripheral blood. Neutropenia, thrombocytopenia, and anemia are usually present.
Patients have symptoms of fatigue, fever and bleeding.
There is often lymph node enlargement. Enlargement of the spleen and of the liver may be seen. The cells depicted in the image below are two lymphoblasts and a neutrophil.