How is leukemia diagnosed?

Your doctor will conduct a physical exam, order blood tests and, if results are suspicious, order imaging tests and a bone marrow biopsy.

Physical exam: Your doctor will ask about any symptoms you are experiencing and check for swollen lymph nodes. (You have lymph nodes throughout your body but some can be more easily felt, such as those in your neck or under your armpits). Your doctor may also look at your gums to see if they are swollen or bleeding, look for bruises or a tiny red skin rash (petechiae) and signs of an enlarged spleen. You may not have many or any obvious symptoms if you have early-stage chronic leukemia. Symptoms can also be relatively common to many other illnesses, such as simply feeling tired or having flu-like symptoms that do not improve.

Complete blood count (CBC): This blood test gives details about red blood cells, white blood cells and platelets. If you have leukemia you will have lower than normal counts of red blood cells and platelets, and higher than normal counts of white blood cells. Some leukemia cells may be found. (Leukemia cells are the still developing immature cells – usually white blood cells – that rapidly multiply in bone marrow and spill over into the bloodstream.)

Blood cell examination. Other blood samples may be taken and checked for type and shape of blood cells and examined for other substances released by your body’s organs and tissues that may be signs of disease. Other tests may help identify chromosomal abnormalities and other markers on the cells that help identify the type of leukemia.

Bone marrow biopsy (also called bone marrow aspiration): If your white blood cell count is abnormal, your doctor will get a sample of cells from your bone marrow. During this procedure, a long needle is used to draw out some fluid from the marrow of your bone, usually from an area near your hip (pelvic bone). A laboratory then examines the blood cells in the fluid under a microscope. A bone marrow biopsy helps determine the percentage of abnormal cells in the bone marrow, which confirms the diagnosis of leukemia.

Bone marrow biopsy taken from the hip.

During a bone marrow biopsy, fluid is removed from the bone marrow and examined under a microscopic.

Imaging and other tests: Your doctor may order a chest X-ray, CT scan, or magnetic resonance imaging (MRI) scan if you have symptoms that indicate a complication of the leukemia. A lumbar puncture (also called a spinal tap) may be ordered to see if the cancer had spread to the spinal fluid surrounding the brain and spinal cord.

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