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Diagnosis of Leukemia

Authors:
  • Amy Scholten, MPH
Publication Type:

Condition InDepth

Diagnosis of Leukemia

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.

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

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

A 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

References

  • Acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL) in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-lymphoblastic-leukemia-lymphoblastic-lymphoma-all-lbl-in-adults.
  • Acute myeloid leukemia (AML). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-myeloid-leukemia-aml.
  • Chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/chronic-lymphocytic-leukemia-cll-small-lymphocytic-lymphoma-sll.
  • Chronic myeloid leukemia (CML). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/chronic-myeloid-leukemia-cml.
  • Kurtin S. Interdisciplinary management of acute leukemia across the continuum of care. Semin Oncol Nurs. 2019;35(6):150953.
  • Overview of leukemia. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/overview-of-leukemia.
  • 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.
  • 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.

Contributors

  • Mohei Abouzied, MD, FACP
Last Updated:
2022-11-01

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.