WHAT TESTS AND PROCEDURES WILL MY CHILD NEED?
The symptoms of ALL, such as looking pale, infections, or bleeding, usually prompt a visit to the primary care provider. Leukemia often is suspected when there are abnormal findings on a blood test called the complete blood count (CBC) or if abnormalities are noticed during a physical exam. To confirm the diagnosis of leukemia, additional testing will be needed. Tests that may be done are listed below.
BONE MARROW ASPIRATION AND BIOPSY A bone marrow biopsy is a test done to determine whether tumor cells are in the bone marrow. A needle is inserted into the marrow inside the bone. Some of the bone marrow (the biopsy) and the fluid in the bone marrow (the aspirate) are collected. Some patients may have a bone marrow sample taken from only one hip bone, while some may have samples taken from both. Patients undergoing bone marrow aspirations and biopsies may experience pain, so children are often sedated for this procedure. Sedation is most often given through an intravenous line (IV). The sedation medications help your child slowly fall asleep and remain comfortable throughout the procedure. If your child is uncomfortable after the test, a mild pain medication such as acetaminophen (Tylenol®) may be given, but not ibuprofen (Motrin® or Advil®) or aspirin as these may increase your child’s risk of bleeding. A specially trained doctor (a pathologist or hematologist) examines the biopsy or aspirate under a microscope to see if white blood cells, red blood cells, and platelets are being produced normally. The doctor also looks for any abnormal cells, such as immature blood-forming cells (blasts), which can indicate leukemia; tumor cells, which can indicate a different type of cancer; or dysmorphic (abnormal-looking) cells, which can indicate a different disease. The bone marrow also is assessed for protein expression of malignant (cancer) cells, which can indicate leukemia, and chromosomal abnormalities, which can diagnose other diseases. Other tests include immune- phenotyping, cytogenetics, and fluorescent in situ hybridization (FISH). During treatment, the bone marrow is checked regularly to determine response to the treatment. The number of cancer cells can be measured and will indicate how well the treatment is working.
IMMUNO-PHENOTYPING
A sample from the bone marrow aspirate will show whether your child has T-cell or B-cell leukemia.
CYTOGENETICS Cytogenetic testing may be another important part of the diagnosis process. Your healthcare team may ask your permission to perform cytogenetic testing on the tumor sample collected during biopsy. Cytogenetic testing includes evaluation of the genes or chromosomes that make up a tumor cell to seek out specific genetic abnormalities that can help determine the most effective treatment for the cancer and identify whether there are specific medications to target the tumor. FLUORESCENT IN SITU HYBRIDIZATION (FISH) FISH is a test that uses special fluorescent dyes that only attach to specific parts of chromosomes. The test can be used to look for specific changes in chromosomes in the leukemia cell. Results from this test may not be available for 1–2 weeks.
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