Diagnosis
Diagnosing leukemia is not always easy, but doctors need to pay extra attention to the signs and symptoms noted above, and their combination. Patients usually come to the doctor with signs and symptoms of infiltration in various organs or abnormal production of bone marrow elements.
The most common symptom is fever with no other sign of infection. These patients require an urgent assessment to treat any infection because they tend to be fatal in the late stages of the disease.
A series of tests are made for diagnosis, which includes a complete blood cell count, and there should be an emphasis on physical examination. The most important tests are as follows:
• Complete blood count
• Peripheral smear
• Fibrinogen, prothrombin time, and activated partial thromboplastin time
• Renal and liver function tests
• Chest radiography and chest computed tomography depending on the symptoms
• Blood cultures and bone marrow aspiration biopsies when there is a high suspicion, and doctors need to have a definite diagnosis.
In blood tests, patients usually have a neutrophil count that is lower than the average, and the total white blood cell count may be either normal, elevated, or lower than normal. Another common finding is anemia (a reduction of hemoglobin in the blood), which correlates with symptoms such as pallor, dizziness, palpitations, and difficulty breathing.
Physical examination typically includes lymphadenopathy (enlarged lymph nodes), and some patients may even have a mediastinal mass that is detected through imaging studies. Another manifestation of the disease is bone pain, which typically results from the infiltration of cells in the bone tissue.
In advanced cases, patients may even come to the emergency room with an altered mental status and respiratory distress. That only happens when there is an excessive number of lymphoblasts in the blood.