Medical history and physical examination: past history, smoking, exposure to chemicals, previous chemo- or radiotherapy treatment. During the physical exam, doctors will inspect your mouth, skin, lymph nodes, liver, and spleen. They will look for signs of bleeding, spots, or infection.
- Complete blood count and peripheral blood smearà to examen the level of cells in blood; the smear allows us to determine whether there is presence of cells with an abnormal morphology.
- Blood chemistry and coagulation tests à Used to check kidney and and kidney function.
- Bone marrow aspiration and biopsy à involves taking a sample of bone marrow (while under local or general anesthesia) or a biopsy; during a biopsy, a small sample of bone is taken following aspiration.
- Cytochemistry à During this text, cells taken from bone marrow are exposed to different stains to see which causes the cells to react. These stains cause color changes in the cells that can be seen through a microscope.
- Flow cytometry and immunohistochemistry à This procedure is often used to determine the subtype of the leukemia using specific antibodies. Cells are exposed to a laser, and if the cells have antibodies attached to them, they will reflect a light that will be measures and analyzed using a computer.
- Cytogenetics à This test makes it possible to examine chromosomes under a microscope, as changes to chromosomes have been seen in many cases of AML. The most common of these alterations are:
- Translocation: genetic material is exchanged between two chromosomes. The most frequent chromosomes that undergo translocation are chromosomes 8 and 21, 15 and 17; these changes are expressed as t (8; 21) and t (15; 21), respectively.
- Inversion of part of chromosome 16, found in reverse order though within the same chromosome. This is written as inv(16)
- Suppression: This involves loss of part of the chromosome. It is written as (7) or -7.
- Addition or duplication: This means part or all of the chromosome has been duplicated, causing too many copies within the cell. It is written as +8.
- Fluorescent in situ hybridization (FISH) à This test is very similar to cytogenetic testing, though using fluorescent stains. These stains become attached to specific genes or parts of the chromosome, making it possible to determine whether translocation has taken place.
- Polymerase chain reaction (PRC) à This is a highly sensitive test that makes it possible to detect certain genetic and chromosomal changes. It is very useful in finding genetic abnormalities in the absence of confirmed chromosomal alterations.
- Imaging tests à Chest x-ray, computed tomography (CT scan), positron emission tomography (PET), MRI, and ultrasound scan.
- Cerebrospinal fluid (CSF) analysis à CSF is only used when there is suspicion of involvement of the brain or central nervous system. In order to confirm this suspicion, the fluid is extracted via lumbar puncture and analyzed for presence of abnormal cells.