c. In chronic myleocytic leukemia the spleen is usually markedly enlarged at the
time the patient presents himself to the physician. The size of the spleen may be
extreme and the organ may extend to the ilium and even to the right anterior superior
spine. The size does not appear to be related to the total number of leukocytes. The
entire course of development of the splenomegaly may be painless, but not infrequently
there is a history of distress in the left upper abdominal quadrant or in the posterior
portion of the body.
d. Pain, limitations of movement, and other symptoms that suggest arthritis,
gout, or osteomyelitis, (or those due to actual fracture of bone) may occur in acute or in
chronic leukemia. These symptoms are common in children. In chronic leukemia, there
may be no symptoms associated with the bones and joints. Bone tenderness can be
elicited if firm pressure is made over the sternum. The patient is frequently unaware of
any tenderness until pressure is applied at the proper point.