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Diagnosing Leukemia


Updated May 27, 2014

Bone Marrow Tests (Aspiration and Biopsy): These are tests that give doctors the opportunity to look at the cells in the marrow. The tests are usually done together at the same time, and may be done in the doctor’s office or clinic.

During this procedure, the patient will get a medication to numb the area where the sample will be taken, usually the hipbone, but possibly the breastbone. Then, using a special needle, a very small piece of bone with marrow (the biopsy) is removed, as well as a sample of just the marrow (the aspiration). These samples are then looked at under the microscope to determine if an abnormality is present.

Spinal Fluid Testing (Lumbar Puncture): The doctor may also choose to test the fluid that surrounds the spinal cord to determine if there are any leukemia cells present. This test, called a lumbar puncture (or “spinal tap”) can be done in the doctor’s office or clinic.

During this procedure, the doctor will have the patient lie on his or her side, or position them leaning forward onto a table so they are “hunched” over. The doctor will then cleanse an area over the spine, and use a small needle to deliver a medication to numb the site. Then, a longer needle is inserted into the back, between the vertebrae, and into the space surrounding the spinal cord. Some fluid will be withdrawn and sent to the lab for further analysis.

Usually, the doctor will have the patient rest in the same position for a short time following the procedure.

Staging Leukemia

Once patients are diagnosed with cancer, they are usually assigned a “stage” which is based on the size of the tumor and whether it has spread from its original site in the body. In the case of leukemia, however, the cancer begins in the bone marrow and spreads throughout the body before it is detected. This makes traditional staging unnecessary.

Physicians will classify leukemia into subtypes based on the characteristics of the leukemia cell’s appearance, specific cell type, and genetic makeup. This classification will help to determine the likely treatment response and prognosis.

Questions To Ask Your Doctor

Tests and procedures can be frightening if you are unsure of what to expect. You may want to write down some questions to ask to help you prepare. Some examples of questions you may want to ask your healthcare provider are:

  • Where will this test be done?
  • What is the procedure for this test?
  • Do I need to bring someone with me?
  • Will I need to fast?
  • Will I be able to return to work after the test?
  • How long will it take to get the results back?
  • How will I get the results?
  • Should I expect any side effects from this test?
  • Will this test be covered by my health plan?

Feel free to take notes while your healthcare provider answers your questions. Have them answer your questions in a different way if you do not understand. Your team will want you to be well informed before any procedures.

Taking Care Of Yourself

If you or your child is being tested for leukemia, this is probably a very scary and stressful time in your life. You may be unsure of the future, worried about what impact a leukemia diagnosis will have on your family. In addition, you may feel physically unwell.

While it is impossible to forget all the stress you are under, it is important to allow yourself some quiet, reflective time each day and time to do the things that bring you joy. Possibly a walk in the sunshine, a chat with an old friend over coffee. Anything that will help you to relax and reconnect with the "old" you. Maybe you will be surprised to see how much better your body feels when your mind is relaxed!


Caldwell, B.(2007). Acute leukemias. In Ciesla,B. (Ed.)Hematology in Practice (pp. 159-185). Philadelphia, Pennsylvania: F.A. Davis Company.

Finnegan,K.(2007). Chronic myeloproliferative disorders. In Ciesla, B. (Ed.) Hematology in Practice (pp.187-203). Philadelphia, Pennsylvania: F.A. Davis Company.

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