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For a medical expert to accurately diagnose leukemia, you will likely need to undergo a combination of tests, including a physical exam and blood work.

Read on to learn what exactly is involved in leukemia testing, what it’s like, and what the results may mean for your overall health.

In some cases, leukemia may be detected during your annual physical exam. But if you have a more rapid-growing case (acute versus chronic leukemia) or if you have not seen a doctor in a while, you may consider getting a checkup based on certain symptoms.

Some common symptoms of leukemia include:

  • night sweats
  • a low-grade fever
  • frequent infections
  • unexplained fatigue
  • shortness of breath
  • bruising easily
  • bleeding easily (such as when you brush your teeth)
  • pale or ashen skin
  • muscle weakness
  • noticeably swollen lymph nodes, especially in your neck or armpits
  • losing weight without trying

In addition to discussing your medical history in depth, your doctor will conduct a physical exam. They may check for signs of:

  • skin infections
  • bleeding inside of your mouth
  • bruising
  • petechiae, which are purplish-brown spots that develop on your skin due to excess bleeding
  • enlarged lymph nodes by feeling your neck and armpit areas
  • pain or tenderness in your muscles or joints
  • a fever by taking your temperature

A primary care doctor or general physician is your first source for a physical exam. Depending on their findings, they may order blood tests or refer you to a cancer specialist (oncologist) to conduct further testing.

If you do not currently have a doctor, you may consider looking for a family physician in your area or calling your insurance company for a list of options. (Below, we also cover what steps you can take to find a doctor for testing and treatment, even if you do not have insurance.)

Leukemia itself starts in the bone marrow, where your blood cells are produced. Your doctor will likely order a complete blood count (CBC) test as the next step following a physical exam.

CBC panel

Like other blood tests, a CBC is derived from a blood sample. Your doctor will insert a needle into a vein in your arm to collect the sample. While an annual physical exam typically includes a CBC, your doctor may order this test when ruling out the possibility of underlying health conditions.

When considering leukemia, your doctor will look at a combination of the following:

  • Blood platelets (thrombocytes). These are responsible for naturally clotting your blood and preventing excess bleeding. With leukemia, a CBC may reveal lower-than-average platelets. These can also confirm physical signs your doctor noticed, such as petechiae and bruising.
  • White blood cells (WBCs). If you have leukemia, your WBCs will likely be elevated. Immature WBCs may quickly increase in number with this cancer, and then change into leukemia cells.
  • Red blood cells (RBCs). Leukemia may cause reduced RBC counts. This may be due to an overcrowding of WBCs, as well as related anemia.

Can I order my own CBC test?

Yes, you can. You can also get a CBC test done on your own through a local lab. This can help provide the information you need to determine any next steps. If you do decide to follow up with a doctor though, keep in mind that they may want their own CBC test done.

Either way, you can expect results from your CBC test within a few business days.

Blood smear

Since other health conditions can cause similar changes in a CBC, your doctor may also order a blood smear test (manual differential) for confirmation. During this test, a pathologist looks at a sample of your blood under a microscope. They’ll look for the size of your blood cells, as well as their proportion and any other atypical characteristics.

You may have heard of genetic tests for cancers such a leukemia. There are two types: genetic diagnostic tests and genetic screening. They each have different purposes.

A genetic diagnostic test looks for certain markers in your genes that could indicate cancer.

On the other hand, genetic screening looks for markers that could indicate a future risk of cancer. Screening tests may be helpful if your family has a history of cancer or if you would like to determine your personal risk in order to keep better tabs on your health.

It’s important to keep in mind that genetic screening is not a 100-percent determination for whether you’ll develop cancer. If you currently have possible leukemia symptoms, you should choose diagnostic testing instead.

If the CBC or blood smear tests are inconclusive, your doctor may consider a bone marrow aspiration (biopsy). This test may help detect leukemia cells directly in your bone marrow before they’re released into your bloodstream.

During a bone marrow biopsy, your doctor will need to collect a sample of your bone marrow through a large needle. They may also take a small sample of bone for further evaluation. This test is done via a large bone, such as your hip bone.

Before they collect the sample, your doctor will apply a numbing agent to your skin. While you may feel pressure during the test, you should not be in pain.

But it’s possible to feel pain and discomfort for a few days after the procedure. Your doctor may recommend applying cold compresses or taking over-the-counter pain relievers such as acetaminophen or ibuprofen.

It may take a few days before your results come back. Your doctor will look for signs of leukemia cells or any other atypical characteristics of your blood cells. They may also be able to detect chromosomal changes that are seen in people who have leukemia.

Cytochemistry tests are similar to blood smear tests in that they’re used to get a closer look at samples from your body under a microscope. The key difference is that your doctor exposes these samples to dyes or stains before examination to see how the cells react.

These tests also primarily look for chromosomal changes. This can help your doctor determine the type of leukemia you have so that they can also recommend the appropriate treatments.

The main types of cytochemistry tests include:

  • Cytogenetics. This uses samples from your blood or bone marrow. A pathologist will look for whether certain proteins called antigens are present in cancer cells.
  • Immunohistochemistry. This is a type of tissue sample test that also looks for antigens and may help determine what kind of cancer you have.
  • Polymerase chain reaction (PCR). This test looks for biomarkers that indicate cancer in samples of your bone marrow or blood.
  • Fluorescent in situ hybridization (FISH). This detects chromosomal changes in blood and bone marrow samples with the help of fluorescent dye. Your doctor may also repeat this test every few months to make sure your leukemia treatment is working.

Imaging tests may be recommended if your doctor suspects that leukemia has spread to your lymph nodes or organs. Your doctor may use these tests to better identify which areas of your body to biopsy. Such tests may come in the form of MRI scans, X-rays, or CT scans.

These imaging tests are typically conducted by technicians. While some of the results may show up immediately, you’ll need to discuss them separately with your doctor at a follow-up appointment.

MRI for leukemia

MRI scans can help determine whether any changes have occurred in soft tissues, organs, or bones as a result of cancer. This test uses a combination of radio waves and magnets to create images of body tissues.

During this test, your technician will have you take off any jewelry you’re wearing. Then you’ll lie down on a table. This table will be pushed directly into the machine’s chamber. The machine itself is loud, and you can expect some rhythmic thumping noises and vibration as it scans you.

Despite the noise, you’ll need to lie completely still during the MRI scan. For this reason, some doctors recommend anesthesia for young children during the test. An MRI scan takes 15 to 45 minutes.

Chest X-ray for leukemia

X-rays work by emitting low doses of radiation to create images. The test takes a few seconds to complete, and you’ll be sitting up comfortably during the process. You may also be asked to hold your breath.

For leukemia, chest X-rays may be used to take a closer look at enlarged lymph nodes. These tests may be ordered if your doctor suspects that leukemia has spread to your lungs.

CT scan for leukemia

CT scans are more advanced forms of X-rays that use computers to create 3-D images. For leukemia, a CT scan may be useful in providing images of lymph nodes and organs.

During the test, you’ll lie down on a table that slides into the scanner. The machine itself moves around your body, taking pictures and sending them back to the computer.

PET scan for leukemia

Positron emission tomography (PET) scans are similar to CT scans, but this type of procedure also utilizes radioactive glucose injections. These are taken up to 1 hour ahead of time to make any cancer cells clearer on the computer images. This test also takes 3-D images.

You’ll need to lie still on a table during the test. The table itself will repeatedly move back and forth through the scanner. The scan itself takes about 45 minutes to complete.

Your doctor can also order the following tests to help diagnose leukemia:

  • a urine sample (urinalysis) to help look for atypical proteins
  • lymph node biopsy, which involves the surgical removal of all or a part of a sample to determine whether leukemia has spread to your lymph nodes
  • spinal tap (lumbar puncture), where your doctor collects a small amount of cerebrospinal fluid to see if any cancer cells have spread to this area of your body

If you’re living with leukemia, you may want to know how to afford all of the necessary diagnostic testing.

If you have medical insurance, talk with the company to see which tests may be covered. You’ll also want to ask the company about copayments and deductibles so that you’re aware of any bills.

Consider the following options:

Private medical insurance

You may consider coverage from the federal government’s Health Insurance Marketplace, which has open enrollment every November 1.

Learn more about enrollment for preexisting conditions.

Another option is to buy coverage directly from a medical insurance company. Some examples of major carriers include Kaiser Permanente, Blue Cross Blue Shield, and Aetna.

Medicare or Medicaid

If you’re at least 65 years old, you qualify for federal Medicare benefits and will need to contact your provider directly to see if you need supplemental coverage to apply for leukemia testing and treatment.

On the other hand, Medicaid covers people under the age of 65 who meet certain income thresholds. Depending on your circumstances and the state you live in, you may even qualify for both Medicare and Medicaid benefits.

Concierge physicians

If you’re looking to pay out of pocket for more personalized care without medical insurance, you may consider a concierge doctor.

These types of physicians have the same background and training as those in other medical facilities. The key difference is that they do not work with insurance companies. You enroll in a membership plan instead.

Cancer treatment centers

These consist of specialists who may help diagnose and treat cancer, including leukemia. Cancer treatment centers may be for-profit, while others are nonprofit organizations that may offer financial support.

Consider organizations such as:

Testing for leukemia involves a combination of diagnostic screening tools, including a physical exam and CBC test. Depending on the results from these initial tests, your doctor may recommend further types of testing, such as biopsies, cytogenetics, and imaging.

Undergoing testing for leukemia may be a lengthy process that can become costly. If you do not have insurance, you still have options for obtaining coverage. You may also consider reaching out to cancer centers for additional support.