Diagnosis
If you have symptoms of CLL, your doctor will take your medical history and conduct a physical exam. If your doctor suspects CLL, samples of your blood and bone marrow will be taken and analyzed for signs of the disease. Your doctor may recommend any of the following procedures as part of this process:
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Bone Marrow Aspiration & Biopsy
Your doctor will perform this procedure to get a sample of your bone marrow for further testing. For this test, a doctor or nurse will numb the patient's hip bone and use a needle to extract some solid bone and some bone marrow. The doctor will then examine the tissue sample under a microscope to see if there are leukemia cells present. This test can be done in the hospital or doctor's office, and most patients can go home right after the test. This test is not necessary for diagnosis but to rule out other things.
Complete Blood Count (CBC)
A complete blood count (CBC) measures the levels of different types of cells in your blood. People with CLL often have high levels of lymphocytes. The cut-off level doctors use for a diagnosis of CLL is anything over 5,000 CLL cells per cubic millimeter.
Peripheral Blood Smear
In this test, a blood specialist will examine a sample of your blood under a microscope. Your doctor will look for abnormal lymphocytes called "smudge cells," which are commonly found in people with CLL.
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Cytochemistry / Immunocytochemistry
In these tests, special stains or antibodies will be applied to a sample of your blood or bone marrow. These substances react with certain types of cells present in leukemia, and produce visible stains that can help the doctor determine if there are any leukemia cells present.
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Flow Cytometry
Doctors commonly use this test to help diagnose CLL. In this procedure, your doctor will expose a sample of your blood or bone marrow to special antibodies that attach themselves only to certain substances in your cancer cells. Your doctor then moves the sample through a laser beam, which causes the antibodies to light up. These studies help your doctor tell normal cells from leukemia cells.
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Cytogenetic Tests
Your doctor will examine your cancer cells for chromosome changes in order to determine the specific characteristics and subtype of your disease. For these tests, your doctor will grow a sample of bone marrow cells in the laboratory and examine the chromosomes under a microscope once the cells start dividing. Cell division is the easiest time to see the chromosomes.
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Fluorescent in situ hybridization (FISH)
Doctors also use this test to detect changes in the chromosomes and DNA of your blood or bone marrow samples. Your doctor will expose the sample to special dyes that will bind to specific parts of certain chromosomes. These dyes help your doctor detect any abnormalities in the chromosomes known to play a role in CLL. This test is much faster than cytogenetic tests because the cell sample doesn't have to be grown in a laboratory.
DNA Sequencing
Sometimes your doctor may use this test to find out if the immunoglobulin heavy chain variable region (IgVH) gene has mutated. CLL with an IgVH mutation usually has a better prognosis.
