Little or no research has been conducted on the epidemiology of leukemias in Eritrea . In this retrospective study, we evaluated the burden and trends of acute lymphoblastic leukemia (ALL), Acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL) and overall leukemia in Eritrea. Methods: An audit of leukemia cases recorded in laboratory logbooks at the National Health Laboratory (NHL) and Orotta Referral and Teaching Hospital (ORTH) between January 2010 and December 2021 was performed. Aside from leukemia sub-types, additional variables that were retrieved included age, sex, years of incidence, residency. Relevant estimates assessed included crude incidence rates (CIR), age-standardised rates (ASIR) and estimated annual percentage change (EAPC). Results: In total, 372 confirmed cases of leukemia were recorded between, 2010-2020. The median [interquartile range (IQR)] age, maximum – minimum age, and male/female ratio were as follows: 48 years (24.5 – 60 years), 2 - 91 years, and 210/161 (1.3: 1), respectively. Estimated all-age CIR and ASIR over the study period was 9.22 per 100 000 and 30.1 per 100 000 respectively. Analysis of cumulative (2010 - 2020) CIR per 100 000 (ASIR per 100 000) for ALL, AML, CLL, and CML were as follows: 2.01(3.87); 0.94(2.38); 2.94(15.37) and 3.61(24.03). Additionally, median (IQR) age differed significantly across different subtypes of leukemia – ALL (23.0 years, IQR: 10.0 – 39.0); AML (30 years, IQR: 20 – 56 years), CLL (59.0 years, IQR: 40.75 – 66.75 years), and CML (49 years, IQR: 39.25 – 60 years), p value (Kruskal Wallis), < 0.05). No sex specific differences were observed in median (IQR) for different types of leukemia. Unlike other leukemia sub-types evaluation of EAPC demonstrated that the incidence of leukemia has increased overtime, 21.9 (95 CI: 3.1-44.1), p-value = 0.025. Conclusions: The burden of leukemia was relatively stable . However, due to underreporting and underdiagnosis, it’s our belief that the true burden of leukemia is likely higher. Further, an upward trend in the burden of ALL was uncovered. Lastly, expansion of diagnostic services to other sub-zones, establishment of a national cancer registry and research remains a priority in Eritrea.