Making the Diagnosis
Most cases of chronic lymphocytic leukemia are found through routine blood tests. Because it progresses very slowly with symptoms that develop gradually, it is often undiagnosed until routine blood tests show a high number of lymphocytes, or white blood cells.
Blood cells, and in most cases, bone marrow cells, must be examined in order to diagnose chronic lymphocytic leukemia. Blood analysis will show an increase in white blood cells. There may also be low platelet counts and red cell counts (anemia), but these are usually only slightly decreased in the early stages. A bone marrow examination may also show a large increase in the number of lymphocytes in the bone marrow, as well as a decrease in normal marrow cells.
If tests results are positive and your doctor diagnoses chronic lymphocytic leukemia, further tests need to take place to establish what subtypes of white blood cells have been affected. The results of these tests will help predict how rapidly or slowly the disorder may advance and will determine what kind of treatment, if any, should be started.
In addition, a sample of marrow, taken by biopsy, may be examined to check for abnormalities in chromosomes. This analysis, referred to as cytogenetics analysis, determines whether there are abnormal chromosomes.
Further blood tests may be done to determine associated abnormalities in blood proteins and immune function that may help to predict possible future complications such as anemia, bleeding, or infection.
The doctor will determine how far the chronic lymphocytic leukemia has progressed (staging). This will help predict the severity of the condition and guide treatment. Staging is based on factors such as the number of lymphocytes in the blood and bone marrow, size of the spleen and liver, the presence or absence of anemia, and platelet count. Usually, death occurs because the bone marrow can't produce enough normal cells to carry oxygen, fight infections, and prevent bleeding.