Blood tests may be the first sign of a problem. They may be done as part of a routine exam. Tests may also be done if there are unexplained symptoms. Swollen lymph nodes, unusual bruising, a lot of infections, or anemia may be caused a blood disorder. They can also be caused by other issues. Tests will help to find the cause.

Diagnosis of Leukemia

Blood Tests

Blood tests will show changes in blood cells. Tests include:

Complete blood count—To see if blood cells are in a normal range.
Blood smear—A drop of blood is looked at in a lab. It can also show the number of each type of blood cell. It will also show how many immature cells are in the blood. The type of cells that are damaged will show the type of leukemia too.

Bone Marrow Aspiration and Biopsy

Bone marrow test is the only way to confirm leukemia.

A bone marrow aspiration takes a sample of bone marrow through a needle. It is often taken from the hipbone. A piece of bone may also be removed for biopsy.

Both marrow and bone sample are looked at in a lab.

Leukemia Details

Results from those tests and new tests will show details about the leukemia. It will help to make a treatment plan.

Other tests may include:

Lumbar puncture—To look for signs of leukemia in the brain and spinal fluid.
Genetic testing of cells

Acute leukemias are aggressive from the start. They are in bone marrow sites all over the body. Cancer often spreads to other organs. Doctors group these by type so they can find the best way to treat them.

Chronic leukemias are not as aggressive. This can change over time. Chronic leukemias are grouped by the type and phase when it is found. In the US, a Rai classification is used for chronic lymphocytic leukemia:

Rai Stage 0 (low risk) —High white blood cell count WITHOUT enlarged lymph nodes, liver, or spleen AND near normal ranges of red blood cells and platelets.
Rai Stage 1 (intermediate risk) —High white blood cell count AND enlarged lymph nodes WITHOUT enlarged liver or spleen and near normal ranges of red blood cell and platelets.
Rai Stage 2 (intermediate risk) —High white blood cell count AND enlarged spleen, possibly enlarged liver WITH or WITHOUT enlarged lymph nodes and near normal ranges of red blood cells and platelets.
Rai Stage 3 (high risk) —High white blood cell count AND low red blood cell count WITH or WITHOUT enlarged lymph nodes, liver, or spleen.
Rai Stage 4 (high risk) —High white blood cell count AND low platelet count WITH or WITHOUT low red blood cell count, or enlarged lymph nodes, liver, or spleen.

Treatment and outcomes depend on many factors such as the grouping, overall health, and age

References:

Acute lymphoblastic leukemia/lymphoma (ALL). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated October 17, 2018. Accessed March 13, 2019.

Acute myeloid leukemia (AML). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated August 14, 2018. March 13, 2019.

Chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated November 21, 2017. Accessed March 13, 2019.

Chronic myeloid leukemia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated January 4, 2018. Accessed March 13, 2019.

Davis AS, Viera AJ, Mead MD. Leukemia: an overview for primary care. Am Fam Physician. 2014;89(9):731-738.

Overview of leukemia. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/overview-of-leukemia. Updated December 2018. Accessed March 13, 2019.

Stages of adult acute lymphoblastic leukemia. National Cancer Institute website. Available at: https://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq#section/_123. Updated October 19, 2018. Accessed December 21, 2018.

Stages of adult acute myeloid leukemia. National Cancer Institute website. Available at: https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq#section/_164. Updated October 19, 2018. Accessed December 21, 2018.

Last reviewed December 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 3/13/2019

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