Further investigations for leukaemia

If acute leukaemia is suspected, a variety of further investigations are required. Some of these may be initiated in the emergency department, although generally they will be the responsibility of the haematologist taking over the patient’s care. These include:

Tests for alternative (non-malignant) causes of cytopaenia

These include B12/folate, HIV, parvovirus B19 and immunoglobulins. The history may suggest other specific tests, for example for liver disease, autoimmune conditions or inherited haematological disorders.

Bone marrow tests

Aspirate (liquid bone marrow) and trephine (a core biopsy of bone) samples are taken from the pelvis by the haematologist under local anaesthesia.

This confirms the specific diagnosis and allows for prognostication and identification of specific targets for novel treatments.

Lumbar puncture

Patients with ALL will need a lumbar puncture to exclude central nervous system involvement, regardless of clinical symptoms. This will be performed by the haematologist.