When Is A Patient Tested For Leukemia
“A patient may be tested for leukemia if he or she has unexplained weight loss, night sweats or fatigue, or if he or she bruises or bleeds easily,” Dr. Siddon says. “Sometimes routine blood work shows an unexplained elevated number of white blood cells.”
People with chronic leukemia are more likely than those with acute forms to be asymptomatic before they are diagnosed.
People with leukemia may feel tired because they don’t have the normal amount of red blood cells, which carry oxygen around the body. They may also bruise or bleed easily because they don’t have enough platelets to facilitate blood clotting, or they may have frequent infections because they arent producing normal white blood cells, which mount an immune response.
Other symptoms, such as night sweats, are more general and less specific to leukemia, but they can be a sign that the body is directing its resources to fighting an illness.
Where Can I Find More Information
If you find that you are interested in learning more about blood diseases and disorders, here are a few other resources that may be of some help:
Results of Clinical Studies Published in Blood
Search Blood, the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, patients interested in viewing an access-controlled article in Blood may obtain a copy by e-mailing a request to the Blood Publishing Office.
Impact Of White Blood Cell Count On Complete Remission Rate Event
When considering all 525 patients, hyperleukocytosis was significantly associated with a lower complete remission rate , shorter event-free survival and shorter overall survival . Furthermore, within the subgroup of patients with cytogenetically intermediate-risk AML, hyperleukocytosis was significantly associated with a lower complete remission rate , shorter event-free survival and shorter overall survival . As expected, in the subgroup of patients with favorable cytogenetic risk, a WBC count below 20×109/L appeared to be significantly associated with a higher complete remission rate , improved event-free survival and improved overall survival . Finally, in the subgroup of patients with cytogenetically unfavorable risk AML, WBC count did not affect the complete remission rate , event-free survival or overall survival .
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Preparing For A Blood Test
Depending on the kind of blood test you are having, you may need to prepare for the test. This may mean fasting for 8 or 12 hours prior to the test, not eating certain foods that may affect the results, or not taking certain kinds of medications. You may also be asked to not smoke or consume alcohol before the test.
It is highly recommended you drink 8 to 10 glasses of water on the days leading up to your test as being hydrated helps with blood flow. Being hydrated also helps veins stick out and be found more easily for the procedure.
How Blood Cancers Affect Blood Counts
Blood cancers can affect blood cell counts in a number of ways, either lowering or increasing measurements. If youre currently receiving cancer treatment such as chemotherapy, drug therapy or radiation, your blood counts will be affected. Blood counts usually return to normal after treatment is complete.
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What Abnormal Results Mean
LOW WBC COUNT
A low number of WBCs is called leukopenia. A count less than 4,500 cells per microliter is below normal.
Neutrophils are one type of WBC. They are important for fighting infections.
A lower than normal WBC count may be due to:
- Bone marrow deficiency or failure
- Cancer treating drugs, or other medicines
- Certain autoimmune disorders such as lupus ( SLE
- Disease of the liver or spleen
- Radiation treatment for cancer
- Certain viral illnesses, such as mononucleosis
- Cancers that damage the bone marrow
- Very severe bacterial infections
- Severe emotional or physical stress
HIGH WBC COUNT
A higher than normal WBC count is called leukocytosis. It may be due to:
- Certain drugs or medicines
- Cigarette smoking
- Infections, most often those caused by bacteria
- Inflammatory disease
There may also be less common reasons for abnormal WBC counts.
Drugs that may lower your WBC count include:
Drugs that may increase WBC counts include:
- Beta adrenergic agonists
How Do Lymphocyte Levels Affect Treatment And Outlook
Although a lymphocyte level of greater than or equal to 5,000 B cells helps doctors make a diagnosis, it does not appear to determine a persons outlook.
Instead, researchers use staging systems for this purpose. A standard staging system for chronic lymphocytic leukemia is the , in which a lower stage indicates a better outlook.
All stages include lymphocytosis. They also include the following:
- Rai stage 0: No spleen, liver, or lymph enlargement, with platelet and red blood cell counts near normal.
- Rai stage 1: Enlarged lymph nodes, but liver and spleen not enlarged, and platelet and red blood cell counts near normal.
- Rai stage 2: Enlarged spleen and possibly enlarged lymph nodes, but platelet and red blood cell counts near normal.
- Rai stage 3: Possibly enlarged liver, lymph nodes, or spleen, and red blood cell count is low, but platelet count is close to normal.
- Rai stage 4: Enlarged lymph nodes, liver, or spleen, low platelet count, and red blood cell count may also be low.
Chronic lymphocytic leukemia often progresses slowly. In many cases, the cancer is not curable, but treatment helps keep the symptoms at bay and slows the progression of the disease.
Not all people with chronic lymphocytic leukemia start treatment immediately after diagnosis. One factor in determining when to start treatment is the level of lymphocytes.
The presence of symptoms of leukemia also indicates the need for treatment to start.
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How To Avoid Infections
A person with leukemia is susceptible to foreign pathogens and less equipped to fight off and heal from infections. This is especially true for a person undergoing chemotherapy as part of their treatment. Having a low white blood cell count means that some infections may become life-threatening, so its important to take steps to help cut down your risk of getting sick when your immune system isnt in its strongest fighting form.
Why We Don’t Stage Most Leukemias
With solid tumors, at the time of diagnosis, we usually say that the cancer is stage I, II, III, or IV, based on how far away the cancer cells have spread from where they began. If you have breast cancer and the cancer is located just in your breast, that is stage I. If it has traveled far from the breast, into the brain or liver, we would consider that stage IV.
But leukemias are in the blood, so at the time of diagnosis, the leukemia cells are already in your blood and bone marrow. They are already throughout the whole body. Thats why we dont stage most of the leukemias as we do with solid tumors. Instead, we say that either you have active disease or the disease is in remission.
The only exception to that is chronic lymphocytic leukemia, or CLL, which acts a little bit more like a lymphoma and can spread throughout the body through lymph, blood, or bone marrow and lymph nodes throughout the body. For that particular type of chronic leukemia, we do say there are stages.
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How Is Leukocytosis Treated
Treatment for leukocytosis varies depending on what caused the condition in the first place. For example, if you have a high white blood cell count due to a bacterial infection, then your healthcare provider will prescribe antibiotics. If leukocytosis is associated with an allergic reaction, then youll probably need antihistamines. Other common high white blood cell count treatments include:
- Medications to reduce stress or anxiety.
- Anti-inflammatory medications.
- IV fluids to improve blood flow.
- Leukapheresis, a procedure to quickly reduce the number of white blood cells in your blood.
- Cancer treatments, such as chemotherapy, radiation therapy or stem cell transplants.
In some cases, your white blood cell count may return to normal without intervention.
Low White Blood Cell Count And Leukemia
A complete blood count is one of several blood tests commonly performed on people who have leukemia or who are suspected of having the condition. A CBC measures the number of each of the main types of blood cells: platelets , red blood cells , and white blood cells . While leukemia typically leads to a high white blood cell count , the condition and some of its treatments can sometimes lead to low white blood cell counts.
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Other Conditions That May Cause Low Wbc Counts
Having a low or high WBC is not always an indication of leukemia. Five percent of people will experience a high or low WBC in their lifetime. In fact, several noncancerous conditions can lead to an abnormal WBC count. For example, autoimmune diseases like rheumatoid arthritis , which can cause high WBCs, and excessive alcohol use can lead to a low WBC count. Certain racial and ethnic groups may naturally have a lower number of circulating WBCs.
Are Certain People At A Higher Risk For Developing Leukemia
Anyone can develop leukemia. Still, studies have shown that certain factors may increase your risk, including:
- Previous cancer treatment. Past cancer treatments involving radiation or chemotherapy may increase the likelihood youll develop some types of leukemia.
- Smoking. If you have a history of smoking or exposure to second-hand smoke, youre at increased risk of developing acute myelogenous leukemia.
- Exposure to industrial chemicals. Benzene and formaldehyde are known cancer-causing chemicals found in building materials and household chemicals. Benzene is used to make plastics, rubbers, dyes, pesticides, drugs and detergents. Formaldehyde is in building materials and household products such as soaps, shampoos and cleaning products.
- Certain genetic disorders. Genetic disorders, such as neurofibromatosis, Klinefelter syndrome, Schwachman-Diamond syndrome and Down syndrome, may increase your risk.
- Family history of leukemia. Research suggests that some types of leukemia may run in families. In most cases, however, having a relative with leukemia doesnt mean that you or another family member will also develop leukemia. Tell your healthcare provider if you or a family member has a genetic condition. They may recommend genetic testing to assess your risk.
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Treatment To Remove Abnormal White Blood Cells
Leukapheresis is a way of removing abnormal white blood cells from the blood. You might have this treatment if you have a very high white blood cell count.
Very high numbers of leukaemia cells in the blood can cause problems with normal circulation. You need to have your blood cell count lowered quickly if this happens. Chemotherapy can lower the number of leukaemia cells in the blood but it takes a few days to work. You might have leukapheresis in the meantime.
If Additional Treatments Are Needed
Leukemia blood cell counts also help to show whether you need additional treatments. For example:
- If you have low red cell counts, you may have anemia, which causes low energy levels. Your doctor may recommend treatment for anemia, such as iron supplements or a blood transfusion.
- If you have low white cell counts and a fever, you may have an infection and need to take antibiotics.
- If your platelet counts are too low, you may have an increased chance of life-threatening bleeding. Your doctor may recommend platelet or blood infusions to lower this risk.
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Pearls And Other Issues
Here are some important considerations regarding leukocytosis:
- Prompt identification of leukocytosis should be performed by clinicians obtaining a CBC, along with chart review for previous CBCs for evaluation of trends.
- Obtain a careful physical examination and history to ascertain the underlying force driving the presenting leukocytosis.
- Consider the patient’s ethnicity, place of birth, geographical location, family, and social history when evaluating a new or chronic leukocytosis. This can help target risk factors for various etiologies for the presenting WBC count.
- Perform a medication reconciliation, as many common medications have been linked to nonspecific leukocytosis.
- Involve appropriate specialists as needed to treat the leukocytosis .
- Be aware of severe complications related to malignancy-associated leukocytosis receiving treatment, to include hyperviscosity syndrome and tumor lysis syndrome.
When Should You Get Tested For Leukemia
If your first alert to leukemia comes from routine blood testing, youre not alone. This happens because early symptoms of leukemia can be vague and easy to miss. Its a good idea to speak with a doctor if you have unexplained:
hydrated and not hungry. Your doctor will let you know in advance if there are any special instructions.
Getting blood drawn for these tests is a simple, routine procedure. The medical professional drawing the blood will place a tight band around your arm and look for the best vein.
After cleaning the skin, theyll insert a small needle into your vein. Blood will flow into small vials, and they will remove the band. Then they will place a cotton ball or bandage on the injection site. It shouldnt take more than a few minutes.
If blood tests make you feel sick or you have a fear of needles, make sure to let the physician giving the test know. Theyll be able to help you stay calm. The blood samples will go to a lab, so it may take several days before you get the results.
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How Is Leukocytosis Diagnosed
Your healthcare provider will perform an exam and ask about your symptoms and medical history. Theyll also order a complete blood count . This common blood test checks for red blood cells, white blood cells and platelets in your blood. A CBC can tell your healthcare provider if you have certain conditions or infections. In some cases, you might need a bone marrow test to confirm your diagnosis.
What Does A Complete Blood Count Measure
A CBC measures the amount of 3 types of cells in your blood:
White blood cell count. A white blood cell count, also called a leukocyte count, measures the total number of white blood cells in a sample of blood. These cells protect the body from infection by attacking invading bacteria, viruses, and other foreign materials in the body. Some white blood cells can also attack cancer cells.
White blood cell differential. A white blood cell differential measures the number of each type of white blood cell.There are 5 major types of white blood cells, andeach type plays a different role in protecting the body. Your doctor can learn valuable information about your health by measuring the levels of these cells:
Red blood cell count. Red blood cells carry oxygen throughout your body. A red blood cell count, also called an erythrocyte count, measures the number of red blood cells in a sample of blood. There are several ways to measure red blood cells. Two of the most common are:
Hematocrit , the percentage of your blood that is made up of red blood cells
Hemoglobin , the amount of the protein in red blood cells that carries oxygen
Platelet count. A platelet count measures the number of platelets in a sample of blood. Platelets help to stop bleeding by forming blood clots.
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What To Do If Youre Diagnosed With Leukemia
If youve received a leukemia diagnosis, youre probably feeling incredibly overwhelmed. The most important thing you can do is reach out to a leukemia specialist, such as the ones at Moffitt Cancer Center. A leukemia expert will be able to address your concerns and provide you with critical information about the next steps to take. Before your initial consultation, you may want to write down a list of questions so that you dont forget anything. You may also consider bringing along a family member or friend to provide emotional support and help remember important pieces of information.
Abnormal Wbc Count Due To Medications
Many prescription and over-the-counter drugs can cause an abnormal WBC count. It is essential always to review your medication history with your healthcare provider.
Certain drugs can cause your WBC count to drop below the normal range of values. These include:
- Antibiotics: Used to treat bacterial infections
- Anticonvulsive drugs: Use to treat epilepsy and chronic pain
- Chemotherapy: Used to treat cancer
- Rituxan : Used to treat autoimmune diseases and certain cancers
Some medicines can raise your WBC count. Some of the more common include:
- Albuterol: Used to treat asthma and other breathing problems
- Beta-blockers: Used to treat high blood pressure
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What Outcome Can I Expect If I Have A Leukemia Diagnosis
Its difficult to predict the prognosis for leukemia because everyones experience is different. Outcomes depend on a variety of factors, including:
- Genetic abnormalities or mutations. The mutations inside leukemia cells are the most important predictor of outcome.
- Type of leukemia. Certain types of leukemia are associated with more favorable outcomes than others.
- Blood cell counts at the time of diagnosis. The number of leukemia cells at your diagnosis can play a role in your outcome.
- Age. Generally, the younger you are at your diagnosis, the better your outcome.
- Health. Generally, the healthier you are at your diagnosis, the better your outcome.
- Response to treatment. The length of time it takes for cancer to go into remission often indicates how successful treatment may be.
- Presence of leukemia cells in your central nervous system. Cells in your spinal fluid are often more difficult to treat.
Ultimately, your healthcare provider is the most reliable resource for understanding how your cancer affects your unique prognosis. Ask them about treatment outcomes.