What is the diagnosis of Leukemia?

Leukemia can be difficult to diagnose based on clinical findings as most signs and symptoms are non-specific. If you have symptoms suggestive of leukemia, your doctor will do tests to findthe cause of your symptoms.

What to expect from your doctor: Your doctor will ask about your symptoms, take your personal and family medical history, examine you and recommend some tests. Some questions that the doctor may ask are:

• When did you the symptoms start?
• Have you received chemotherapy or radiotherapy in the past?
• Do you have a family member who has had leukemia?
• What seems to improve your symptoms or makes your symptoms worse?

During physical examination, the doctor will look for swollen lymph nodes, spleen, or liver.
Blood tests: Sample of your blood will be sent to the lab for examination. This sample is tested for size, number and maturity of different blood cells (white blood cells, red blood cells and platelets). Findings suggestive of leukemia include presence of numerous undeveloped white blood cells, low levels of platelets and hemoglobin (the protein present inside red blood cells).
Biopsy: If blood tests and symptoms are suggestive of leukemia, the doctor will take the bone marrow tissue to look for cancer cells. This is the definitive test for diagnosis and confirmation of the type of leukemia. The bone marrow sample is taken under local anesthesia (this reduces the pain on taking sample) from your hipbone or another large bone. The sample is examined by a pathologist (a doctor who specialises in diagnosing diseases by looking at cells and tissues under a microscope) for the presence of leukemia cells under the microscope. Ways to obtain bone marrow sample include:

• Bone marrow aspiration: In this procedure, a thick and hollow needle is used to remove samples of bone marrow.
• Bone marrow biopsy: Bu virtue of this procedure, a very thick and hollow needle is used to remove a small piece of bone and bone marrow.

Cytogenetics: If leukemia is diagnosed, the chromosomes of the cells from samples of blood, bone marrow or lymph nodes may be examined to check for any abnormality. For example, in chronic myelocytic leukemia (CML), an abnormal chromosome called the Philadelphia chromosome may be present. Identification of abnormal chromosomes can show what type of leukemia you have, probable response to treatment and prognosis.

Spinal tap: The cerebrospinal fluid (fluid present around the brain and spinal cord, which protects your brain and spinal cord) may be taken for examination. The fluid is removed under local anesthesia from the lower spine using a long, thin needle. It is examined for leukemia cells or other signs of the disease.

These are some tests that are done if leukemia is suspected. Other tests that may be done include chest x-ray, computed tomography scan (CT or CAT scan) and magnetic resonance imaging (MRI) scan to determine the extent of disease.