How acute myeloid leukaemia (AML) is diagnosed
Usually you will see your family doctor (GP) who will examine you and take a blood test. If the results of the test are abnormal, your GP or a haematologist from the hospital will contact you.
A haematologist is a doctor who specialises in treating blood problems. They will arrange for you to be seen quickly at the hospital for further tests and treatment.
Most people with AML are referred to a specialist haematology unit in the hospital. The haematologist will ask about your general health and any previous medical problems you’ve had. They’ll examine you to check if your lymph nodes, spleen or liver are enlarged. You’ll also have more blood samples taken to check the number of different cells in your blood and to look for leukaemia cells.
If the blood test results are abnormal, the haematologist will want to take a sample of your bone marrow. This is an important test, as it helps the haematologist find out more about the leukaemia and gives them the information they need to plan the best treatment for you.
Bone marrow sample (biopsy)
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A small sample (biopsy) of bone marrow is taken from the back of your hipbone (pelvis) or occasionally the breast bone (sternum). This is usually done by a doctor or specialist nurse. A doctor who specialises in cells (a pathologist) or a haematologist will look at the sample under a microscope to identify the type of leukaemia. They will also count the number of immature blood cells (blasts) in the sample and carry out other tests on the sample to help confirm the diagnosis.
Before the bone marrow sample is taken, you’ll be given a local anaesthetic injection to numb the area. A thin needle is then passed through the skin into the bone. A small sample of the bone marrow (bone marrow aspirate) is drawn into a syringe to be looked at later under a microscope. The procedure can be done on the ward or in the outpatients department, and takes about 15-20 minutes.
It can be uncomfortable when the marrow is drawn into the syringe, but this should only last for a very short time. You may be offered a short-acting sedative to reduce any pain or discomfort during the test.
Sometimes a small core of marrow is needed (trephine biopsy), and this procedure takes a few minutes longer. A special type of needle, which is a bit thicker than the one used to take an aspirate sample, is passed through the skin and bone into the bone marrow. The doctor will push the biopsy needle in and gently turn it back and forth. When the needle is withdrawn, it will contain a 1-2cm core of bone marrow.
You may feel bruised after having a sample of bone marrow taken, and have an ache for a few days. This can be eased with mild painkillers.
Your doctor may arrange for you to have other tests to check that your lungs, liver, kidneys and heart are healthy. These can include a chest x-ray, further blood tests, an electrocardiogram (ECG) and an echocardiogram.