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: To check 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: To remove some bone marrow from your hipbone or another large bone to 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. 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: A thick, hollow needle is used to remove samples of bone marrow.
  • Bone marrow biopsy: A very thick, hollow needle is used 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 chronic myelogenous leukemia (CML) have an abnormal chromosome called the Philadelphia chromosome.
  • Spinal tap: Some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord) is removed from the lower spine with a long, thin needle to remove fluid. 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.