Diagnosis
If you have symptoms of CML, your doctor will take your medical history and conduct a physical exam to determine what might be causing them. If your doctor suspects CML, samples of your blood and bone marrow will be taken and checked 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
The doctor will always perform this procedure if CML is suspected. 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 check for leukemia cells. This test can be done in the hospital or doctor's office, and most patients can go home right after the test.
Blood Tests
A specialist may choose to do blood tests to check for any abnormalities. These tests may include:
- Peripheral Blood Smear: In this test, a blood specialist will examine a sample of your blood under a microscope. Your doctor will look at the appearance and amount of the different cells in your blood and look for any abnormalities that may indicate CML.
- Complete Blood Count (CBC): A complete blood count (CBC) measures the levels of different types of cells in your blood. People with CML often have too many abnormal granulocytes in their blood. The abnormal cells may crowd out healthy blood cells and cause conditions like anemia, leukopenia, and thrombocytopenia.
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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 be seen under a microscope.
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Flow Cytometry
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. This test helps your doctor identify the specific types of cells in your leukemia, helping him get a better idea of the maturity and origin of the cancer cells. This test is particularly important in advanced phases (blast phases) to differentiate between myeloid and lymphoid types of transformations.
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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 lab 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 CML. This test is much faster than cytogenetics tests because the cell sample doesn't have to be grown in a lab.
Polymerase Chain Reaction (PCR)
The doctor may perform this DNA test on a sample of your blood or bone marrow. Doctors use this test to detect chromosome abnormalities that cannot be seen under a microscope because they are too small. This test is very sensitive and can detect these abnormalities even if there are very few leukemia cells in the sample.
