Diagnostic Tests for Leukemia
Leukemia: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Leukemia
includes:
Leukemia Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Leukemia:
- Colon & Rectal Cancer: Home Testing
- Fatigue: Related Home Tests:
- more tests »
Leukemia Diagnosis: Book Excerpts
- Approach to the Diagnosis - LYMPHADENOPATHY, GENERALIZED
- Approach to the Diagnosis - WEAKNESS AND FATIGUE, GENERALIZED
- Approach to the Diagnosis - RASH, GENERAL
- History and physical examination - Seizures, generalized tonic-clonic
- Diagnosis - Acute leukemia
- Diagnosis - Chronic lymphocytic leukemia
- History and physical examination - Seizures, generalized tonic-clonic
- History - Lymphadenopathy, Generalized
- Diagnosis - Leukemia, acute
- Diagnosis - Leukemia, chronic lymphocytic
- Diagnosis - Leukemia, chronic granulocytic
- History - Seizures, generalized tonic-clonic
- History - Seizures, generalized tonic-clonic
- History and physical examination - Seizures, generalized tonic-clonic
- Approach to the Diagnosis - LYMPHADENOPATHY, GENERALIZED
- Approach to the Diagnosis - WEAKNESS AND FATIGUE, GENERALIZED
- Approach to the Diagnosis - RASH, GENERAL
Tests and diagnosis discussion for Leukemia:
To find the cause of a person's symptoms, the doctor asks
about the patient's medical history and does a physical exam.
In addition to checking general signs of health, the doctor
feels for swelling in the liver; the spleen; and the lymph
nodes under the arms, in the groin, and in the neck.
Blood tests also help in the diagnosis. A sample of blood
is examined under a microscope to see what the cells look like
and to determine the number of mature cells and blasts.
Although blood tests may reveal that a patient has leukemia,
they may not show what type of leukemia it is.
To check further for leukemia cells or to tell what type of
leukemia a patient has, a hematologist ,
oncologist ,
or pathologist
examines a sample of bone marrow under a microscope. The
doctor withdraws the sample by inserting a needle into a large
bone (usually the hip) and removing a small amount of liquid
bone marrow. This procedure is called bone
marrow aspiration . A bone
marrow biopsy is performed with a larger needle and
removes a small piece of bone and bone marrow.
If leukemia cells are found in the bone marrow sample, the
patient's doctor orders other tests to find out the extent of
the disease. A spinal tap (lumbar
puncture ) checks for leukemia cells in the fluid that
fills the spaces in and around the brain and spinal cord
(cerebrospinal
fluid ). Chest x-rays
can reveal signs of disease in the chest. (Source: excerpt from What You Need To Know About Leukemia: NCI)
Diagnosis of Leukemia: medical news summaries:
The following medical news items
are relevant to diagnosis of Leukemia:
Diagnostic Tests for Leukemia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Leukemia.
Seizures, generalized tonic-clonic:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If you didn’t witness the seizure, obtain a description from the patient’s companion. Ask when the seizure started and how long it lasted. Did the patient report unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of a headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Also, ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Seizures, generalized tonic-clonic:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you didn’t witness the seizure, obtain a description from the patient’s companion. Ask when the seizure started and how long it lasted. Did the patient report any unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have any other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lymphadenopathy, Generalized:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General. A comprehensive physical examination should be performed on all patients with generalized lymphadenopathy. Focus on those findings consistent with the most frequent causes of generalized lymphadenopathy. Note the patient’s temperature and weight, because fever and weight loss are frequent findings. Examine the skin, mucous membranes, abdominal organs, and joints; specifically, the presence of rash, mucocutaneous ulceration, organomegaly, and arthritis can be a guide to possible causes of the adenopathy. The presence of splenomegaly in a patient with adenopathy implies a systemic illness (e.g., infectious mononucleosis, lymphoma, leukemia, lupus, sarcoidosis, toxoplasmosis, or cat scratch disease) (Chapter 15.4). Additionally, search for other abnormal lymph nodes. Studies have shown that clinicians identified only 17% of those cases of generalized lymphadenopathy when it was present (1).
B. Nodal examination. The abnormal lymph node groups should be specifically examined.
1. Size. Lymph nodes enlarged up to 1 cm in diameter can be considered normal in size. These have a low malignancy risk and can usually be observed. Lymph nodes greater than 1.5 cm × 1.5 cm in area have been shown to have a 38% risk of cancer involvement and merit further workup (2).
2. Location. Anterior cervical, submandibular, and inguinal nodes are normally palpable. The presence of supraclavicular adenopathy is always abnormal and carries a 90% cancer risk in those aged more than 40 years. Postocciptal nodes are associated with infectious mononucleosis, scalp lesions, toxoplasmosis, and non-Hodgkin’s lymphoma. Axillary nodes are associated with upper extremity infections, breast cancer, cat scratch disease, and lymphomas. Epitrochlear nodes are associated with pyogenic infections, sarcoidosis, tularemia, and syphilis. Inguinal nodes are associated with lower extremity infections and sexually transmitted diseases.
3. Pain. The presence or absence of pain is not a reliable indicator of the cause of adenopathy. Capsular swelling from acute infections can cause pain as can necrotic hemorrhage from a malignant lymph node.
4. Consistency. Rock hard nodes are consistent with metastatic disease (2). Firm rubbery nodes are found with lymphomas. Soft nodes tend to occur with infectious causes; however, this should not be considered diagnostic.
Testing
A. Primary laboratory test. Initial laboratory testing should include a complete blood count (CBC) and a slide test for infectious mononucleosis (IM) (1). Atypical lymphocytes are suggestive of IM, cytomegalovirus, or toxoplasmosis. Neutropenia is found with viral illness, lupus, brucellosis, and bone marrow replacement. Severe anemia can be seen with malignancy and autoimmune processes. If the initial mononucleosis spot is negative, the test should be repeated at intervals of 1, 2, and 3 weeks, if atypical lymphocytes are present in the CBC.
B. Secondary testing. If the initial laboratory results are nondiagnostic, order a purified protein derivative (PPD), antinuclear antibody, hepatitis B surface antigen, HIV, rapid plasma reagin, cytomegalovirus serology, and chest X-ray (CXR) study. Although the CXR is seldom positive, it can be helpful in finding tuberculosis (TB), histoplasmosis, lymphoma, or sarcoidosis. Although a PPD will not be diagnostic of TB, it can be helpful in differentiating sarcoid from TB on a node biopsy (2).
C. Lymph node biopsy. If the aforementioned laboratory testing is nondiagnostic, then lymph node biopsy may be indicated. The largest and most pathologic node should be removed. Axillary and inguinal nodes should be avoided as they often reveal only reactive hyperplasia. Biopsy should be avoided in cases of suspected IM and drug reaction because the histologic picture is easily confused with malignant lymphoma (2). Experienced hematologists or hematopathologists should handle all specimens. The value of fine needle aspiration is controversial, with reasonable arguments both for and against (4).
Diagnostic assessment
Generalized lymphadenopathy merits evaluation beyond mere observation, as a specific systemic illness will be the likely cause. The history and examination should focus on infectious, autoimmune, granulomatous, and malignant causes. If a specific entity is suspected based on the history and physical examination, then that entity should be specifically evaluated. In the event the cause is unclear, first order a CBC and mononucleosis spot. If these are negative, then serologic testing and a CXR are warranted. Consider lymph node biopsy in those cases where the node is rock hard or larger than 1.5 cm × 1.5 cm in size (1). Biopsy should be avoided in those cases where viral causes are clinically suggested.
References
1. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician 1998;58:1313–1320.
2. Pangalis GA, Vassilalopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570–582.
3. Williamson HA. Lymphadenopathy in a family practice. J Fam Pract 1985;20:
449–452.
4. Henry P, Longo D. Enlargement of lymph nodes and spleen. Harrison’s on line 1999;61. www.harrisonsonline.com/
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Seizures, generalized tonic-clonic:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness. If you haven’t already done so, take the patient’s vital signs. Then complete your neurologic assessment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Seizures, generalized tonic-clonic:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you didn't witness the patient's seizure, obtain a description from his companion. Ask when the seizure started and how long it lasted. Did the patient report unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Also, ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
Next, assess the patient's level of consciousness (LOC) and proceed with a complete neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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