Step 3:

History: - Pale, often fever, bleeding, weight loss, anorexia, general weakness. - There are complaints enlarged lymph nodes and abdomen, sometimes there is bone pain. Examination: hildren appear lethargic, anemic, there!s bleeding in the skin or other organs, enlarged lymph nodes in the neck, slenomegali and hepatomegaly. "nvestigations #. Peripheral blood: there!s anemia, thrombocytopenia, le$kocyte co$nt can le$kopenia, normal, or hiperle$kositosis, gained dominance in lymphocyte co$nts. %. &one marrow aspiration to confirm the diagnosis '. ($mbar p$nct$re can be performed no infiltration into the cerebrospinal fl$id

Step 4 Diagnosing Leukemia Physical exam and medical history: )hen healthcare providers are investigating a patient for le$kemia, they will almost always begin with a thoro$gh physical exam and medical history. They will be interested to know details abo$t any symptoms yo$ are experiencing and will do a complete head-to-toe assessment. *$ring the early stages of le$kemia, there may be no symptoms. +any of the symptoms of le$kemia don,t become apparent $ntil a large n$mber of normal blood cells are crowded o$t by le$kemia cells.

Symptoms of Chronic and Acute Leukemia In acute leukemia, symptoms $s$ally appear and get worse -$ickly. People with this disease $s$ally go to their doctor beca$se they feel sick. In chronic leukemia, symptoms develop grad$ally and are generally not as severe as in ac$te le$kemia. hronic le$kemia is $s$ally fo$nd d$ring a ro$tine doctor,s exam before symptoms are present. )hen symptoms appear, they generally are mild at first and grad$ally get worse, b$t sometimes they don,t worsen $ntil many years after an

initial diagnosis. .ecently, researchers discovered that abnormal white blood cells can be present in the blood of chronic lymphocytic le$kemia patients more than six years before a diagnosis. This finding may lead to a better $nderstanding of the cell$lar changes that occ$r in the earliest stages of the disease and how the disease progresses.

hite !lood Cell Le"els #ay !e $igh People with le$kemia may have very high levels of white blood cells, b$t beca$se the cells are abnormal, they are $nable to fight infection. Therefore, patients may develop fre-$ent fevers or infections. / shortage of red blood cells, called anemia, can ca$se a person to feel tired. 0ot having eno$gh blood platelets may ca$se a person to bleed and br$ise easily. 1ome symptoms depend on where le$kemia cells collect in the body. (e$kemia cells can collect in many different tiss$es and organs, s$ch as the digestive tract, kidneys, l$ngs, lymph nodes, or other parts of the body, incl$ding the eyes, brain, and testicles. %ther Common Symptoms 2ther common symptoms of le$kemia incl$de headache, weight loss, pain in the bones or 3oints, swelling or discomfort in the abdomen 4from an enlarged spleen5, and swollen lymph nodes, especially in the neck or armpit. 1ymptoms of ac$te le$kemia may incl$de vomiting, conf$sion, loss of m$scle control, and sei6$res. 1ome of the symptoms of le$kemia are similar to those ca$sed by the fl$ or other common diseases, so these symptoms are not s$re signs of le$kemia. "t is important to check with yo$r doctor if yo$ have these symptoms. 2nly a doctor can diagnose and treat le$kemia.

La&oratory examination: The treatment plan will depend on the specific kind of le$kemia that the patient have.

A &lood test is $s$ally eno$gh to find signs of chronic lymphocytic le$kemia 4 ((5. &lood tests, like a & 4complete blood co$nt5 can detect le$kemia. / & determines the n$mber of red blood cells, white blood cells, and platelets. "t also can co$nt the n$mber of red blood cells that make $p the blood sample and the amo$nt of hemoglobin in the blood. / peripheral blood smear may also be done. / peripheral blood smear determines the presence of blast cells and reveals the type and -$antity of white blood cells. ytogenic analysis is a blood test in which a sample of blood is examined to check for changes in the chromosomes of the lymphocytes. This blood test may also be ordered.

/ doctor may order other blood tests to see how organs are f$nctioning. This can reveal is cancer is affecting the organ,s f$nctionality.

Tests that look closely at $n$s$al cells, chromosomes, or proteins on cells can show what type or s$btype of le$kemia yo$ have. These tests incl$de: o / test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow 4cytogenetic analysis5.
o

/ test that compares cancer cells to normal blood cells to find the specific kind of le$kemia 4imm$nophenotyping5. / test to look for genes that are 7t$rned on7 in several types of le$kemia, s$ch as ac$te myelogeno$s le$kemia 4/+(5. This test is called a reverse transcription-polymerase chain reaction test, or .T-P ..

These tests can help g$ide treatment. 1ometimes they can help yo$r doctor and yo$ know whether yo$r le$kemia is likely to go into remission or come back. "n some cases, the tests can predict s$rvival rates. 8o$r doctor may also order other tests, incl$ding:

hest 9-rays, to find o$t if le$kemia or an infection is the ca$se of l$ng problems s$ch as persistent co$ghing, co$ghing $p blood, chest pain, or tro$ble breathing. T scan of the head, chest, and belly, to find o$t if le$kemia has spread there. ($mbar p$nct$re, to find o$t if le$kemia cells are in yo$r cerebrospinal fl$id 4 1:5. / l$mbar p$nct$re or spinal tap may be done to diagnose le$kemia. ;nder an anesthetic, a small amo$nt of spinal fl$id is removed from the spaces between the vertebrae in the spine. The fl$id is then examined by a pathologist. +." of the brain, to look into symptoms s$ch as conf$sion, paralysis, n$mbness, vision problems, vertigo, or headaches. Those symptoms co$ld mean that le$kemia has spread to the brain. / biopsy of a lymph node or other tiss$es, to look for le$kemia cells. &iopsy is a proced$re in which a sample of cells are removed from the body to be examined for cancer. &one marrow aspiration is a type of biopsy $sed to diagnose le$kemia. / fine needle is inserted into the hip or breast bone and a sample of the bone and bone marrow is removed. "t is then examined by a pathologist. / lymph node biopsy made be performed also, depending on the type of le$kemia s$spected. / lymph node is removed and then examined by a pathologist.

!lood'ork: To do these tests, blood will $s$ally be taken from a vein in yo$r arm. The cells are then looked at $nder a microscope. ommon blood tests for le$kemia incl$de:

Complete !lood Count (C!C): Tests to meas$re levels of red cells, white cells, and platelets in the body as well as how the cells look. Peripheral !lood Smear: &lood cells are dyed and looked at $nder a microscope for the presence of immat$re <blast= cells.

Summary %f Leukemia !lood'ork *esults Disease Acute #yelogenous Leukemia (A#L) Acute Lymphocytic Leukemia (ALL) Chronic #yelogenous Leukemia (C#L) C!C *esults !lood Smear *esults >(ower than normal amo$nts of >Too many immat$re white red cells and platelets cells >(ower than normal amo$nts of >Too many immat$re white red cells and platelets cells >.ed blood cell co$nt is >+ay still show some decreased and the white cell immat$re white cells co$nt is often very high >+ainly high n$mbers of >Platelet levels may be increased f$lly mat$re, b$t or decreased depending on the dysf$nctional cells stage of the disease >.ed cells and platelets may or >(ittle or no immat$re may not be decreased white cells >"ncreased n$mbers of >Possibly fragments of red lymphocytes cells

Chronic Lymphocytic Leukemia (CLL)