Chronic myelogenous leukemia laboratory tests

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[3] Mohamad Alkateb, MBBCh [4] Sima NoorAli, M.D.

Overview

Laboratory findings of chronic myelogenous leukemia in CBC include leukocytosis with a left shift, thrombocytosis, absolute basophilia and eosinophilia, monocytosis and normal or elevated platelet count. Elevated uric acid levels and elevated histamine levels are other laboratory findings.

Laboratory Findings

Laboratory findings consistent with the diagnosis of chronic myelogenous leukemia include:[1][2][1]

Blood tests:

Differential blood test:

  • A differential (diff), which is a count of the different types of white blood cells in a peripheral blood sample.

Peripheral blood smear:

  • Increase in immature myeloid cells at various stage of maturation (i.e. myelocytes and band cells).
Bone marrow test:
  • Increase in immature myeloid cells at various stage of maturation (i.e. myelocytes and band cells).
  • Presence of translocation between chromosomes 9 and 22.
  • Presence of BCR-ABL transcripts by RT-PCR.

Blood chemistry tests:

  • Increased creatinine in some cases.
  • Increased liver enzymes in some cases.

Conventional cytogenetics and karyotyping:

  • This test looks at chromosomes under a microscope.
  • The chromosomes can best be seen when the cell is dividing, so a sample of blood or bone marrow must be grown in vitro so that the cells start to divide.
  • The leukemia cells in all CML patients contain an abnormal chromosome called the Philadelphia (Ph) chromosome, which looks like a shortened version of chromosome 22.

Fluorescent in situ hybridization (FISH):

  • FISH is another way to look at chromosomes and is more precise than conventional cytogenetics because it uses fluorescent dyes that only attach to specific genes or parts of chromosomes.
  • In CML, FISH can be used to look for specific pieces of the BCR-ABL gene on chromosomes.

Polymerase chain reaction (PCR):

  • This is a highly sensitive test that can be used to look for the BCR-ABL product in leukemia cells. PCR is useful for quantitation.
  • It can be done on blood or bone marrow samples and can detect very small amounts of BCR-ABL, even when Philadelphia chromosome can not be detected with cytogenetic testing.
  • It can be used after treatment to see if copies of the BCR-ABL gene are still present.
  • If copies of this gene are found it means that the leukemia is still present.

References

  1. 1.0 1.1 Thompson PA, Kantarjian HM, Cortes JE (October 2015). "Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015". Mayo Clin. Proc. 90 (10): 1440–54. doi:10.1016/j.mayocp.2015.08.010. PMC 5656269. PMID 26434969.
  2. Wang YL, Bagg A, Pear W, Nowell PC, Hess JL (October 2001). "Chronic myelogenous leukemia: laboratory diagnosis and monitoring". Genes Chromosomes Cancer. 32 (2): 97–111. PMID 11550277.
  3. Center for Disease Control and Prevention. Public Health Image Library 2015.http://phil.cdc.gov/phil/details.asp

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