• Prolonged or excessive bleeding, bruising easily
• Bleeding gums
• Nosebleeds
• Bleeding into the skin
• Menstrual irregularities
• Skin rash or lesion
  • Pinpoint red spots (petechiae)
  • Bruises (ecchymoses )
• Paleness
• Fatigue
• Infection
• Sternal tenderness
• Bone pain or tenderness
  • Breastbone (sternum)
• Joint pain
  • Hip pain
  • Knee pain
  • Ankle pain
  • Foot pain over small joints of the foot
  • Shoulder pain
  • Elbow pain
  • Wrist pain
  • Hand pain over small joints of the hand
• Lymphadenopathy (enlarged glands)
• Unintentional weight loss
• Fever
• Swollen gums
• Shortness of breath (made worse by exercise)
• Sensations of feeling the heart beat (palpitations ) with an irregular pattern

A physical exam and lab tests may reveal the following:

• Enlarged liver and spleen
• Bruising (ecchymosis)
• Evidence of bleeding (petechiae, purpura)
• Abnormal WBC count  
• A CBC shows anemia  
• Low platelet count
• A bone marrow aspiration shows an increased number of cells (hypercellularity) and an increase in lymphoblasts.

ALL may also alter the results of the following tests:

• T (thymus derived) lymphocyte count
• Cell surface antigen studies (B-cell, leukemia/lymphoma panel)
• White blood cell differential

Classification of ALL now depends on a number of sophisticated tests, such as immunophenotyping, karyotyping, and terminal deoxynucleotidyltransferase (TdT) activity. The combined results of these tests allows pinpoint molecular diagnosis, which helps guide the treatment decisions, and clarify the likely prognosis.

For instance, the cells of some leukemias contain chromosomal abnormalities. Those with the Philadelphia chromosome or with the t(4;11) translocation would tend to have a poor prognosis, thus intensive treatment and an early bone marrow transplant might be recommended immediately. Other genes (such as the TEL/AML1 rearrangement) can indicate a very favorable prognosis.