Diagnostic tests for acute myeloid leukaemia (AML)
A combination of blood and bone marrow tests will help your doctor confirm the diagnosis and work out the subtype of AML you have.
Learn more about these tests to diagnose AML:
- Blood tests
- Bone marrow tests
- Further tests
Your doctor will take a sample of blood and send it to a laboratory for a full blood count (FBC). This will show whether leukaemia cells are present in the blood and whether the levels of the main blood cells are different to what would be expected in a healthy person.
Blood cells develop in your bone marrow, so your doctor will want to check a sample of your bone marrow for signs of leukaemia. There are two ways to collect a bone marrow sample:
- bone marrow aspiration – the doctor uses a thin needle to remove a small amount of fluid (aspirate) from the bone marrow, usually from the hipbone (pelvic bone)
- bone marrow biopsy or trephine – the doctor uses a slightly larger needle to remove a small amount of bone and marrow.
You will be given a local anaesthetic to numb the area, pain relief that you inhale (commonly known as the green whistle) or light sedation to help you relax. Pain medicine may make you feel drowsy, so ask a family member or friend to drive you home afterwards. Although it can take up to 30 minutes to prepare for a bone marrow test, the actual procedure takes only a few minutes.
The bone marrow sample (biopsy) is sent to a laboratory, and a specialist called a pathologist will view the sample under a microscope to work out the subtype of acute leukaemia. Doctors use this information to suggest the most suitable treatment.
Various tests may be done on the biopsy sample, including:
This uses a machine (flow cytometer) to look for certain markers or signals on the surface of the cell. These markers or signals are called antigens. Looking at the patterns of antigens can help your doctor work out whether you have AML or ALL, and what subtype it is.
These specialised tests are used to work out the potential benefit of having complex treatments such as a stem cell transplant, and the chance of the AML coming back (recurring) after a period of improvement (remission).
Every kind of cancer, including blood cancer, changes the genes of the affected cells. These gene faults are not the same thing as genes passed through families. The fault is only in the structure of the leukaemia cells, not in normal cells. The study of these gene changes is called cytogenetics or molecular genetics.
Tests known as FISH (fluorescence in situ hybridisation) and PCR (polymerase chain reaction) are used to look for the most common gene changes in AML. The PCR test may also be used to check how well treatment has worked, and if further treatment is needed.
Other molecular tests are becoming more routine. Such tests may include looking for changes in genes that may affect treatment choice or outcomes. The commonly tested genes are known by abbreviations such as FLT3, NPM1 and CEBPA.
You may have other tests to find out more about the AML, and to check your general health and how well your organs are working.
A chest x-ray is taken to check the heart and lungs, and to see whether there are enlarged lymph nodes in the chest. Enlarged lymph nodes are sometimes seen in people with AML.
Lactate dehydrogenase (LDH)
This enzyme is released into the blood when cells are damaged or destroyed. A blood test can check LDH levels, which will usually be raised in people with AML.
Human leukocyte antigen (HLA) typing
If having a stem cell transplant may be an option, your blood or bone marrow sample will be tested for human leukocyte antigen (HLA). HLA is found on most cells in your body and it helps your immune system recognise which cells belong in your body. A transplant can only go ahead if the stem cell donor is a close match to your HLA type. This is why your close relatives may also have an HLA test.
This involves a blood test that checks for HIV (human immunodeficiency virus) or hepatitis infection.
Gated heart pool scan
This scan is used to see how well the heart is working. A small amount of your blood is taken, mixed with some radioactive material and injected back into your body. A special camera known as a gamma camera takes pictures of the blood being pumped by your heart.
A computerised tomography (CT) scan uses x-rays and a computer to create cross-sectional pictures of the body. It can show if your lymph nodes are affected and if your spleen is enlarged. A dye (contrast) may be injected beforehand to make the pictures clearer.
This scan uses echoes from soundwaves to create a picture of the body’s organs on a screen.
A magnetic resonance imaging (MRI) scan uses a large magnet and radio waves to take detailed cross-sectional pictures of the body. Tell your doctor if you have a pacemaker, as the magnetic waves can interfere with some pacemakers. In some cases, a dye (contrast) is injected beforehand to make the pictures clearer.
|For an overview of what to expect during all stages of your cancer care, visit Cancerpathways. This is a short guide to what is recommended, from diagnosis to treatment and beyond.|
Dr Anoop Enjeti, Senior Staff Specialist Haematologist, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle; Ray Araullo, Deputy Head, Social Work Department, Royal North Shore Hospital; Shehaan Fernando, Consumer; Narelle Greentree, Clinical Nurse Specialist, Hunter Haematology Unit, Calvary Mater Newcastle; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Karen Maddock, Haematology Clinical Nurse Consultant, Westmead Hospital; Melanie Sexton, Consumer; Dr Jonathan Sillar, Haematology Registrar, Calvary Mater Newcastle, and Conjoint Fellow, The University of Newcastle.
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