Leukemia Diagnosis

Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what's causing the problems. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests:

• Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.
• Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.
• Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells.

  There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

  • Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
  • Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests

The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:

• Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
• Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
• Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

You may want to ask your doctor these questions before having a bone marrow aspiration or biopsy:

• Will you remove the sample of bone marrow from the hip or from another bone?
• Where will I go for this procedure?
• Will I have to do anything to prepare for it?
• How long will it take? Will I be awake?
• Will it hurt? What will you do to prevent or control the pain?
• Are there any risks? What are the chances of infection or bleeding after the procedure?
• How long will it take me to recover?
• How soon will I know the results? Who will explain them to me?
• If I do have leukemia, who will talk to me about next steps? When?