Blood Tests to Diagnose Leukemia

To diagnose leukemia, a number of blood tests are performed. These tests are used to evaluate the type and quantity of blood cells that are present, the blood chemistry, and other factors. Full blood count is used to establish the numbers of different blood cell types in the circulation. A low number of red or white blood cells is described as anemia or leukopenia, respectively. A low number of "young" red blood cells (reticulocytes) is called reticulocytopenia. A high leukocyte or reticulocyte count is called leukocytosis or reticulocytosis. A lack of mature neutrophils (bacteriadestroying white blood cells) is known as neutropenia or granulocytopenia. Thrombocytopenia is the term used for a low number of blood-clotting platelets, and thrombocytosis refers to a high number of platelets. Differential blood count (DBC) is used to determine the relative proportion of blood cell types within the bloodstream. In particular, the percentage of immature leukemic "blast" cells is noted. People with acute leukemia (either acute lymphocytic leukemia [ALL] or acute myelogenous leukemia [AML]) often have too many leukocytes (white blood cells), too few erythrocytes (red blood cells) and/or too few platelets. In many of these patients, the leukocytes are immature "blast" cells. Hematocrit assay is used to determine the proportion of the blood that is occupied by erythrocytes (red blood cells). In adult men, normal is about 46% (39.852.2) and in adult women, it is about 40.9% (34.946.9). In the hemoglobin level test, the level of oxygen-carrying pigment in the erythrocytes is measured. In men, normal levels are 15.5 g/dL blood (13.317.7) and in women, normal levels are 13.7 g/dL blood (11.715.7). Blood coagulation variables are used to determine whether there are problems with clotting. These variables include prothrombin time, partial prothrombin time (PPT), clotting time, coagulation factors II, V, VII, IX, X, XI, and XII, plasminogen, and plasminogen activator.

Blood morphology and staining is used to identify abnormalities in cell shape, structure, and the condition of the cell nucleus. Some abnormalities common to red blood cells include anisocytosis (excessive variations in size), poikilocytosis (abnormal red blood cell shapes), and macrocytosis (abnormally large cells). Neutrophils often show nuclear and cell-based abnormalities, as well as loss of granulation. Platelets may show giant forms that are deficient in granules. In blood chemistry tests, the type and amount of enzymes, minerals, and other substances within the blood are measured. Typical tests include measuring the serum enzyme lactic dehydrogenase; measuring the leukocyte enzyme alkaline phophatase, especially for the diagnosis of chronic myelogenous leukemia, or CML; measuring serum vitamin B12, which can be increased to roughly 15 times normal in CML patients; and measuring serum levels of calcium, potassium, phosphate, and uric acid (excess uric acid in the blood, or hyperuricemia, is common in lymphocytic leukemia and lymphoma). These tests are used to identify kidney or liver damage that may be caused by leukemic cell breakdown or by drugs used for chemotherapy.

Imaging Studies to Diagnose Leukemia

Imaging studies may be used to determine if leukemia has invaded other organs within the body.

Imaging tests include the following: X-rays (to detect enlarged lymph nodes in the chest, a localized mass in the lungs, or evidence of spread to the outer bones or joints) Computed tomography (CT or CAT) scan is a computer-assisted x-ray that produces cross-sectional images of the body. CT scans are not often used in leukemia patients unless the physician suspects that the disease has spread. In such cases, CT scans can help detect changes in the lymph nodes around the heart, windpipe (trachea), or abdomen. Lymph node enlargement is more common in patients with acute or chronic lymphocytic leukemia (ALL, CLL). Magnetic resonance imaging (MRI) scan is a procedure that uses electromagnets and radio waves to create computer-generated pictures of the internal organs. MRI may be used if the physician suspects that leukemia involves the brain or lungs. Radionuclide (radioactive atom) scanning may be performed to rule out nonleukemic disorders in patients who complain of bone pain. In this test, the radiologist injects a radioactive chemical (e.g., gallium-67), which will accumulate in areas of infection or malignancy and can be viewed with a special camera. This procedure is not used for patients who already have been diagnosed with leukemia. Ultrasound is an imaging test based on the principle that solids reflect sound waves in a manner that can be converted into a picture. During ultrasound, a transducer "probe" releases high-frequency sound waves that bounce off the internal organs, are collected, and are transmitted onto a video screen to create a picture called a sonogram. Ultrasound may be conducted to check the kidneys for leukemia-related damage.

Medical Tests, Diagnosis & Detection

In order to establish a correct diagnosis of leukemia, the doctor follows several steps. Anamnesis (detailed medical review of past health state): One of the first steps in establishing a leukemia diagnosis is a detailed and complex medical review of a patient's past health problems and general health state, family medical history, leukemia risk factors, and symptoms. Physical examination During a physical examination, the doctor looks for changes to the internal organs like swelling of the liver, spleen, or lymph nodes from the neck, underarms, and groin area.

Laboratory Tests

Blood test: A blood test allows the pathologist to examine the blood cells under a microscope. The examination criteria are: (1) the blood cells' general appearance, (2) the number of each type of blood cells (red and white cells, and platelets), (3) the cell maturation stage, and (4) the presence or absence of leukemia blast cells. Blood tests are also conducted to diagnose and establish the type of leukemia. Bone marrow test: This test allows the pathologist to examine the marrow cells. It usually confirms the presence or absence of leukemia and the leukemia type. The bone marrow sample can be collected in two ways: (1) through a bone marrow aspiration - the bone marrow sample is removed with a thin needle inserted into the marrow of a large bone, and (2) through biopsy - the bone marrow sample is removed together with the bone tissue.

Spinal tap: This test allows the pathologist to examine the cerebrospinal fluid (the fluid located in and around the brain and spinal cord), and to confirm the presence of leukemia cells. A cerebrospinal fluid sample is removed through a lumbar puncture. A thin needle is inserted into the space around the spinal cord and removes a sample of fluid. This test is performed only when the leukemia diagnosis was confirmed with the purpose of establishing whether or not the leukemia cells had spread to other internal organs. Immunophenotyping: An immunopheno type test helps identify the chemicals located on the cells' surface and diagnose the disease by placing various sorts of strain on bone marrow, blood, or lymph nodes cells. For leukemia, the pathologist uses antigens (proteins) and the bodys antibodies. The antibodies react to certain antigens. This test helps in identifying leukemia cells (if present), the type of leukemia cells (lymphocytic or myelogenous cells), and the cell subtype, which helps establish a treatment approach. Cytogenetics or chromosome analysis. This test analyzes the shape and number of the chromosomes from the leukemia cell, and can identify the chromosome alteration and sometimes the gene mutation. The advantages of this test are: (1) it identifies the specific leukemia type involved, (2) it helps with establishing an effective treatment plan, and (3) it allows follow-up evaluations of the treatment effectiveness.

Imaging Techniques The purpose of these techniques is to locate masses of leukemia cells inside the body. Some of the most used imaging techniques are:

Chest X-rays: An x-ray test uses high energy electromagnetic radiation to penetrate the body and create an image of the body's interior on film. An x-ray can reveal any possible mass of leukemia cells in the chest. Ultrasounds: Ultrasound imaging is a medical technique that uses high-frequency sound waves to create an interior image of the body on a special computer screen. This image is formed from the echoes of the sound waves on the surface of the organs. Abnormal tissue masses and organs reflect sound waves differently. This test involves a device called a transducer that is placed on the upper part of the abdomen, and a computer that translates this sound into an image. Ultrasound imaging is a safe, noninvasive and fast test that can detect leukemia cell masses. Usually, ultrasounds are used to detect whether or not the liver, kidneys, or the spleen were invaded by the leukemia cells. Bone or Gallium Scan: This is usually used to detect whether or not the bone pain (a symptom of leukemia) is caused by a tumor. This type of bone scan uses a radioactive form of gallium which collects in the areas where there are leukemia cells or infections. Computed Tomography (CT): This imaging test is similar with an x-ray test, and creates a detailed cross-sectional image of the body.

A CT scan is usually performed in two steps for a better diagnosis outcome: 1). First, the targeted area is scanned without a contrast agent. 2). Second, the targeted area is scanned after a contrast agent was administrated, and the two are compared.

Magnetic Resonance Imaging (MRI): This imaging technique uses radio waves and strong magnets to reveal a complete image of the body targeted area. The energy from the radio waves is absorbed by the tissues and then revealed into a recognizable pattern on a special monitor.

Diagnosis:
If you are experiencing symptoms of leukemia, your condition may be diagnosed by performing the following tests:

Physical Examination:
In the initial inspection, your doctor would check and see if there is an enlargement of the lymph nodes in the neck, armpits or in the groin region. your liver and spleen may also be examined to see if there is any swelling there as well.

Complete Blood Count Test:

A complete blood count test may be done to determine the levels of white blood cells and platelets which in turn would help determine if you might have leukemia.

Bone Marroe Biopsy Or Aspiration:

In a bone marrow aspiration, a small quantity of the fluid and cells present inside the bone is taken with a needle and is examined. This test is done to detect the presence of leukemia cells. In a bone marrow biopsy, a little amount of bone is also taken along with the marrow and is examined under a microscope. This test is also done to determine the existence of leukemia cells.

Cytogenetics:
A cytogenetic analysis test provides information on the organization of chromosomes and also helps determine changes in the arrangement of the chromosomes. By detecting the presence of the altered chromosome , the type of leukemia could be determined. For example, people affected by chronic myelogenous leukemia have the abnormal philadelphia chromosome.

X- Ray:
If you start coughing out blood or are experiencing breathing problems, an x-ray of your chest may be done to see if leukemia cells are present. Apart from these tests a CT scan or a lumbar puncture may be done to determine the if leukemia has spread to other areas of the body or if it is present in the cerebrospinal fluid. An MRI scan may also be done to see if the brain has been affected by leukemia.