If a person has symptoms that suggest leukemia, the doctor may do a physical exam and ask about the patient's personal and family medical history. The doctor also may order laboratory tests, especially blood tests.

The exams and tests may include the following:

• Physical exam—The doctor checks for swelling of the lymph nodes, spleen, and liver.

• Blood tests—The lab checks the level of blood cells. Leukemia causes a very high level of white blood cells. It also causes low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs that leukemia has affected the liver and kidneys.

• Biopsy—The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope. The removal of tissue to look for cancer cells is called a biopsy. A biopsy is the only sure way to know whether leukemia cells are in the bone marrow.

  There are two ways the doctor can obtain bone marrow. Some patients will have both procedures:

  • Bone marrow aspiration: The doctor uses a needle to remove samples of bone marrow.

  • Bone marrow biopsy: The doctor uses a very thick needle to remove a small piece of bone and bone marrow.

  Local anesthesia helps to make the patient more comfortable.

• Cytogenetics—The lab looks at the chromosomes of cells from samples of peripheral blood, bone marrow, or lymph nodes.

• Spinal tap—The doctor removes some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the spinal column. The procedure takes about 30 minutes and is performed with local anesthesia. The patient 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—The x-ray can reveal signs of disease in the chest.

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