Leukemia Diagnosis

Diagnosis for leukemia begins with a medical history and physical exam. The medical history notes any reported leukemia symptoms. Diagnosis of leukemia requires more than a reviewing simple list of symptoms, however.

Physical examination may reveal signs of swelling in the spleen, liver or lymph nodes. If the medical history and results of the physical exam indicate the possibility of leukemia, your doctor may recommend testing to screen for different types of leukemia.

Complete Blood Count and Diagnosis of Leukemia

If your doctor suspects leukemia, she may order a complete blood count, revealing information on blood composition, including counts of:

  • Platelets
  • Red blood cells
  • White blood cells (WBC).

Leukemia is often associated with high WBC counts. However, low WBC levels may also indicate cancer, depending on your differential blood count results.

Differential Blood Count

A complete blood count includes a white blood cell differential count, which measures the proportions of different types of white blood cells in your blood. Normally, different white blood cells are present in these levels:

  • Basophils: 0.4 to 1 percent
  • Eosinophils: 1 to 3 percent
  • Lymphocytes: 25 to 35 percent
  • Monocytes: 4 to 6 percent
  • Neutrophils: 50 to 70 percent.

WBC counting helps distinguish between cancer, inflammatory diseases and other conditions.

Bone Marrow Biopsy

The next step in diagnosing leukemia is a bone marrow analysis. During a bone marrow biopsy or aspiration, a needle is inserted into a large bone (usually the hip) to remove a bone marrow sample.

The bone marrow sample is processed and examined for signs of cancer. Your doctor may analyze the blast cell count in your bone marrow. Normal bone marrow has relatively few immature “blast” cells, but if you have leukemia, these may account for 30 to 100 percent of your total bone marrow.

Bone Marrow Biopsy - Leukemia Diagnosis

Lymphoid and Myeloid Leukemia Diagnosis

The material removed during bone marrow sampling is used to make the final diagnosis of leukemia. The sample is examined to determine the specific type of leukemia present. Methods of examination include the following:

  • Cell morphology: A pathologist examines the cells appearance.
  • Cytochemistry : A pathologist stains your cells with dyes and tests cellular enzyme levels.
  • Immunophenotyping: A pathologist uses specific diagnostic antibodies to detect proteins expressed on malignant cells.

Treatment options and survival rates vary, depending on whether lymphoid or myeloid leukemia is diagnosed.

DNA and Chronic or Acute Leukemia Diagnosis

Other tests study cells at the genetic level to diagnose leukemia. Cytogenetic studies assess the number and integrity of DNA chromosomes in blood or a bone marrow sample. The DNA can then be examined for mutations. These specific chromosomal and genetic alterations can help determine individual prognosis and define appropriate treatment strategies.

Imaging Tests: Has the Disease Spread?

Once a medical diagnosis is made, diagnostic imaging tools determine if the cancer has metastasized, or spread to other organs. This may be done using diagnostic tools such as:

  • CT scans
  • MRI imagery
  • X-rays.


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Nabili, S. (n.d.). Complete blood count (CBC). Retrieved March 10, 2010, from http://www.medicinenet.com/complete_blood_count/article.htm.

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National Library of Medicine. (2009). Blood differential. Retrieved March 16, 2010, from http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm.

RnCeus Staff. (n.d.). White blood cell count (WBC) and differential. Retrieved March 10, 2010, from http://www.rnceus.com/cbc/cbcwbc.html.