I am writing you because I am only 15 and I don't want my parents to know how scared I am. I have been having serious nosebleeds for the past three months. We thought it was the weather, so we have been trying nose sprays and the humidifier. Then I heard about how with leukemia you get nosebleeds and bruise in odd places. That really scared me because I wake up with more bruises than I went to sleep with. I would like to know if it is possible that I have leukemia or if I am just overexaggerating.

Jamie

We have a saying in medicine, "Common things are common." Translation: even though we (doctors and patients) need to worry about uncommon problems, the most common problems are still the most probable ones.

How does this apply to you? You do, indeed, need to worry about leukemia. But that doesn't mean that you HAVE leukemia -- only that you need to take steps to "rule out" (eliminate the possibility of) leukemia. It is far more likely that there is an innocent explanation for your symptoms, but you still need to take steps to ensure that you don't have a problem that is both rare and serious.

A simple blood test will go a long way toward ruling out leukemia. You need to have a "complete blood count (CBC) with manual differential." This is a blood test in which a trained technician will look at your blood cells under a microscope. If any unusual cells are present (and leukemia cells are very unusual), the technician will notice them.

I certainly do not check a CBC for every patient who complains of frequent nosebleeds, but if some other suspicious symptom is present, I will order a CBC. In your case, the fact that you bruise easily is a suspicious symptom. Once again, this does not mean that you have leukemia, only that you have two unexplained symptoms which could indicate a serious problem with your blood's ability to clot. Leukemia is only one of many possible explanations for such a clotting problem.

I can imagine a variety of harmless explanations for your problems, all of which are far less scary than leukemia. Nevertheless, you owe it to yourself to take these symptoms very seriously. Talk to your parents at once, and see to it that they take you to your pediatrician or family doctor. Make sure the doctor "sees the big picture," just as you have presented it to me in your letter. If it will help, show your parents and the doctor this column. Let the doctor know that you are worried about whether you have a serious problem with your blood's ability to clot, and that you are particularly concerned about leukemia.