Leukemia Diagnosis, Staging, and Questions

Technician holding blood sample
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The signs and symptoms of leukemia and other blood cancers can be vague and may be the same as many other less serious conditions. It is very important for the doctor to have an accurate diagnosis to:

  • Predict how the disease will progress
  • Determine the most effective treatment

Usually, when a person shows signs or symptoms of leukemia, they are referred to a specialist called a hematologist or oncologist.

This will be the physician that will determine the diagnosis, as well as plan any treatments if required.

Diagnosing Leukemia

Physical exam and medical history: When healthcare providers are investigating a patient for leukemia, they will almost always begin with a thorough physical exam and medical history. They will be interested to know details about any symptoms you are experiencing and will do a complete head-to-toe assessment.

Bloodwork: To do these tests, blood will usually be taken from a vein in your arm. The cells are then looked at under a microscope. Common blood tests for leukemia include:

  • Complete Blood Count (CBC): Tests to measure levels of red cells, white cells, and platelets in the body as well as how the cells look.
  • Peripheral Blood Smear: Blood cells are dyed and looked at under a microscope for the presence of immature “blast” cells.

Summary Of Leukemia Bloodwork Results

DiseaseCBC ResultsBlood Smear Results
Acute Myelogenous Leukemia (AML)•Lower than normal amounts of red cells and platelets•Too many immature white cells
Acute Lymphocytic Leukemia (ALL)•Lower than normal amounts of red cells and platelets•Too many immature white cells
Chronic Myelogenous Leukemia (CML)•Red blood cell count is decreased and the white cell count is often very high
•Platelet levels may be increased or decreased depending on the stage of the disease
•May still show some immature white cells
•Mainly high numbers of fully mature, but dysfunctional cells
Chronic Lymphocytic Leukemia (CLL)•Red cells and platelets may or may not be decreased
•Increased numbers of lymphocytes
•Little or no immature white cells
•Possibly fragments of red cells

Bone Marrow Tests (Aspiration and Biopsy): These are tests that give doctors the opportunity to look at the cells in the marrow. The tests are usually done together at the same time, and may be done in the doctor’s office or clinic.

During this procedure, the patient will get a medication to numb the area where the sample will be taken, usually the hipbone, but possibly the breastbone. Then, using a special needle, a very small piece of bone with marrow (the biopsy) is removed, as well as a sample of just the marrow (the aspiration).

These samples are then looked at under the microscope to determine if an abnormality is present.

Spinal Fluid Testing (Lumbar Puncture): The doctor may also choose to test the fluid that surrounds the spinal cord to determine if there are any leukemia cells present. This test, called a lumbar puncture (or “spinal tap”) can be done in the doctor’s office or clinic.

During this procedure, the doctor will have the patient lie on his or her side, or position them leaning forward onto a table so they are “hunched” over. The doctor will then cleanse an area over the spine, and use a small needle to deliver a medication to numb the site. Then, a longer needle is inserted into the back, between the vertebrae, and into the space surrounding the spinal cord. Some fluid will be withdrawn and sent to the lab for further analysis.

Usually, the doctor will have the patient rest in the same position for a short time following the procedure.

Staging Leukemia

Once patients are diagnosed with cancer, they are usually assigned a “stage” which is based on the size of the tumor and whether it has spread from its original site in the body. In the case of leukemia, however, cancer begins in the bone marrow and spreads throughout the body before it is detected.

This makes traditional staging unnecessary.

Physicians will classify leukemia into subtypes based on the characteristics of the leukemia cell’s appearance, specific cell type, and genetic makeup. This classification will help to determine the likely treatment response and prognosis.

Questions To Ask Your Doctor

Tests and procedures can be frightening if you are unsure of what to expect. You may want to write down some questions to ask to help you prepare. Some examples of questions you may want to ask your healthcare provider are:

  • Where will this test be done?
  • What is the procedure for this test?
  • Do I need to bring someone with me?
  • Will I need to fast?
  • Will I be able to return to work after the test?
  • How long will it take to get the results back?
  • How will I get the results?
  • Should I expect any side effects from this test?
  • Will this test be covered by my health plan?

Feel free to take notes while your healthcare provider answers your questions. Have them answer your questions in a different way if you do not understand. Your team will want you to be well informed before any procedures.

Taking Care Of Yourself

If you or your child is being tested for leukemia, this is probably a very scary and stressful time in your life.

You may be unsure of the future, worried about what impact a leukemia diagnosis will have on your family. In addition, you may feel physically unwell.

While it is impossible to forget all the stress you are under, it is important to allow yourself some quiet, reflective time each day and time to do the things that bring you joy. Possibly a walk in the sunshine, a chat with an old friend over coffee. Anything that will help you to relax and reconnect with the "old" you. Maybe you will be surprised to see how much better your body feels when your mind is relaxed!


Caldwell, B.(2007). Acute leukemias. In Ciesla,B. (Ed.)Hematology in Practice (pp. 159-185). Philadelphia, Pennsylvania: F.A. Davis Company.

Finnegan,K.(2007). Chronic myeloproliferative disorders. In Ciesla, B. (Ed.) Hematology in Practice (pp.187-203). Philadelphia, Pennsylvania: F.A. Davis Company.

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