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Diagnosis of leukemia
Last reviewed: 06.07.2025
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In peripheral blood tests of patients with acute leukemia, blast cells, anemia, and thrombocytopenia are detected. However, in 10% of children with acute leukemia, peripheral blood tests do not show any abnormalities. If acute leukemia is suspected, a bone marrow puncture should be performed. The myelogram typically shows suppression of erythro- and thrombopoiesis and an abundance of blast elements. Cytochemical studies are useful for the differential diagnosis of acute lymphoblastic leukemia and ONLL. To identify variants of acute lymphoblastic leukemia, specific markers should be sought using labeled monoclonal antibodies.
In order to combine the cytochemical and morphological bases for differentiation of acute leukemia, the FAB (French-American-British - FAB) classification was created in 1976-1980, which is clear and accessible.
Differential diagnosis of leukemia. Acute leukemia should be differentiated from leukemoid reactions in severe bacterial infections, drug disease, poisoning. Unlike leukemia, such patients do not have a pronounced proliferative syndrome, bone lesions, in the bone marrow and peripheral blood there are all transitional elements between blasts and mature forms to one degree or another. Sometimes certain difficulties are caused by differentiating acute leukemia from infectious mononucleosis, infectious lymphocytosis. In most cases, the clinical picture allows differentiating these diseases (tonsillitis, fever, hepatosplenomegaly, painful on palpation and enlarged lymph nodes are typical for mononucleosis), but the final judgment is still based on morphology: abundant basophilic cytoplasm, the absence of nuclear changes characteristic of leukemia allow diagnosing mononucleosis. In all doubtful cases, it is necessary to perform a myelogram, which is indicated for any unclear anemia, thrombocytopenia, pancytopenia, hepatosplenomegaly, generalized or sharp local enlargement of the lymph nodes.
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