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:

Children appear lethargic, anemic, theres bleeding in the skin or other organs, enlarged lymph nodes in the neck, slenomegali and hepatomegaly.

Investigations

1. Peripheral blood: theres anemia, thrombocytopenia, leukocyte count can leukopenia, normal, or hiperleukositosis, gained dominance in lymphocyte counts. 2. Bone marrow aspiration to confirm the diagnosis 3. Lumbar puncture can be performed no infiltration into the cerebrospinal fluidStep 4

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. During the early stages of leukemia, there may be no symptoms. Many of the symptoms of leukemia don't become apparent until a large number of normal blood cells are crowded out by leukemia cells.

Symptoms of Chronic and Acute Leukemia In acute leukemia, symptoms usually appear and get worse quickly. People with this disease usually go to their doctor because they feel sick.

In chronic leukemia, symptoms develop gradually and are generally not as severe as in acute leukemia. Chronic leukemia is usually found during a routine doctor's exam before symptoms are present. When symptoms appear, they generally are mild at first and gradually get worse, but sometimes they don't worsen until many years after an initial diagnosis. Recently, researchers discovered that abnormal white blood cells can be present in the blood of chronic lymphocytic leukemia patients more than six years before a diagnosis. This finding may lead to a better understanding of the cellular changes that occur in the earliest stages of the disease and how the disease progresses.

White Blood Cell Levels May Be High

People with leukemia may have very high levels of white blood cells, but because the cells are abnormal, they are unable to fight infection. Therefore, patients may develop frequent fevers or infections. A shortage of red blood cells, called anemia, can cause a person to feel tired. Not having enough blood platelets may cause a person to bleed and bruise easily.

Some symptoms depend on where leukemia cells collect in the body. Leukemia cells can collect in many different tissues and organs, such as the digestive tract, kidneys, lungs, lymph nodes, or other parts of the body, including the eyes, brain, and testicles.

Other Common Symptoms

Other common symptoms of leukemia include headache, weight loss, pain in the bones or joints, swelling or discomfort in the abdomen (from an enlarged spleen), and swollen lymph nodes, especially in the neck or armpit. Symptoms of acute leukemia may include vomiting, confusion, loss of muscle control, and seizures.

Some of the symptoms of leukemia are similar to those caused by the flu or other common diseases, so these symptoms are not sure signs of leukemia. It is important to check with your doctor if you have these symptoms. Only a doctor can diagnose and treat leukemia.Laboratory examination:The treatment plan will depend on the specific kind of leukemia that the patient have.

A blood test is usually enough to find signs of chronic lymphocytic leukemia (CLL). Blood tests, like a CBC (complete blood count) can detect leukemia. A CBC determines the number of red blood cells, white blood cells, and platelets. It also can count the number of red blood cells that make up the blood sample and the amount of hemoglobin in the blood.

A peripheral blood smear may also be done. A peripheral blood smear determines the presence of blast cells and reveals the type and quantity of white blood cells. Cytogenic 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.

A doctor may order other blood tests to see how organs are functioning. This can reveal is cancer is affecting the organ's functionality. Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. These tests include:

A test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow (cytogenetic analysis).

A test that compares cancer cells to normal blood cells to find the specific kind of leukemia (immunophenotyping).

A test to look for genes that are "turned on" in several types of leukemia, such as acute myelogenous leukemia (AML). This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.

These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.

Your doctor may also order other tests, including:

Chest X-rays, to find out if leukemia or an infection is the cause of lung problems such as persistent coughing, coughing up blood, chest pain, or trouble breathing. CT scan of the head, chest, and belly, to find out if leukemia has spread there.

Lumbar puncture, to find out if leukemia cells are in your cerebrospinal fluid (CSF). A lumbar puncture or spinal tap may be done to diagnose leukemia. Under an anesthetic, a small amount of spinal fluid is removed from the spaces between the vertebrae in the spine. The fluid is then examined by a pathologist. MRI of the brain, to look into symptoms such as confusion, paralysis, numbness, vision problems, vertigo, or headaches. Those symptoms could mean that leukemia has spread to the brain.

A biopsy of a lymph node or other tissues, to look for leukemia cells. Biopsy is a procedure in which a sample of cells are removed from the body to be examined for cancer. Bone marrow aspiration is a type of biopsy used to diagnose leukemia. A fine needle is inserted into the hip or breast bone and a sample of the bone and bone marrow is removed. It is then examined by a pathologist.

A lymph node biopsy made be performed also, depending on the type of leukemia suspected. A lymph node is removed and then examined by a pathologist.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 plateletsToo many immature white cells

Acute Lymphocytic Leukemia (ALL)Lower than normal amounts of red cells and plateletsToo many immature white cells

Chronic Myelogenous Leukemia (CML)Red blood cell count is decreased and the white cell count is often very highPlatelet levels may be increased or decreased depending on the stage of the diseaseMay still show some immature white cellsMainly high numbers of fully mature, but dysfunctional cells

Chronic Lymphocytic Leukemia (CLL)Red cells and platelets may or may not be decreasedIncreased numbers of lymphocytesLittle or no immature white cellsPossibly fragments of red cells