Tests for acute myeloid leukaemia (AML)

You usually have several tests to check for AML. This might include some or all of the following:

• blood tests
• bone marrow tests
• a lumbar puncture
• testing for changes to genes and chromosomes
• a chest x-ray
• scans

Tests your GP might do

Most people see their GP with symptoms of blood cancer such as leukaemia. Depending on the symptoms some people may go to accident and emergency (A and E) first.

Your GP can do some tests to help them decide whether you need a referral to a specialist. Or they may send you to the hospital straight away to have tests.

Possible tests your GP might do include:

• blood tests
• a physical examination - your GP feels, looks and listens for any changes to your body

Blood tests

Your GP might arrange for you to have blood tests. You usually have these at your GP surgery or your local hospital. Blood tests can give an idea of your general health and if certain systems in your body are working normally, such as your liver or kidneys.

If they suspect AML, you’ll have a full blood count (FBC) to check for changes in your levels of blood cells .

Physical examination

Your doctor will usually do a head to toe assessment. Things they will look for include signs of bleeding, bruising and infection. They might also ask you questions about your wee and poo.

They will listen to your chest and tummy (abdomen) to find out if they sound normal. For example, they can listen for signs of fluid collecting.

They will also feel your abdomen for any areas that aren’t normal, such as swollen or painful areas.

Tests your specialist might do

If your GP thinks you might have a type of leukaemia they'll arrange for you to go to the hospital. This is usually quite quick and sometimes you might have to go there straight away.

The specialist you see is called a haematologist. This is a doctor that specialises in diseases of the blood.

Your specialist usually does more tests and will repeat your blood tests. The other tests might include:

• a bone marrow test
• a lumbar puncture
• a test to check for certain proteins (immunophenotyping)
• different laboratory tests to check for changes to chromosomes and genes
• tests to check for infections
• a chest x-ray
• an ultrasound scan
• tests for tissue typing

Bone marrow test

You have a bone marrow test to confirm you have AML. You also have it to:

• find out which type of AML you have

• check for changes in the chromosomes and genes

• monitor how well you are responding to treatment

Bone marrow is the spongy tissue and fluid that is inside your bones. It makes your blood cells.

There are 2 main types of bone marrow test: 

• bone marrow aspiration

• bone marrow trephine biopsy

Aspiration means your doctor or nurse draws some liquid bone marrow up into a syringe.

A bone marrow trephine biopsy means they remove a very thin 1 or 2cm long core of bone marrow in one piece.

You usually have both these tests done at the same time. They give some of the same information to the doctor, but there are differences. The bone marrow trephine shows the structure of the bone marrow inside the bone, whereas the aspiration takes just the bone marrow cells.

Immunophenotyping (flow cytometry)

Doctors look for certain proteins (antigens ) in your blood sample. These antigens are on the surface of leukaemia cells. This test is called immunophenotyping.

A specialist laboratory does the test. Doctors use a technique called flow cytometry to do immunophenotyping. This process uses antibodies to find cells with certain antigens on their surface. Doctors do this test on a blood, bone marrow or fluid sample.

This is an important test that can quickly look at the features of each cell. It helps find out what:

• type of leukaemia you have, such as AML or another type of leukaemia

• subtype of AML you have

• risk group you are and the likelihood of the leukaemia staying away

It can also help find out how well treatment is working and if your leukaemia has gone away after treatment.

Changes to chromosomes and genes

You have several different tests that look for changes:

• on the surface of the leukaemia cells

• in the genes and chromosomes of the leukaemia cells

Your doctor does these tests on your blood or bone marrow samples. They are looking for any abnormalities. There are different types of tests. They are called cytogenetic, molecular analysis or polymerase chain reaction (PCR) tests.

FISH (fluorescence in situ hybridisation)

FISH is another type of test looking at gene and chromosome changes. The FISH technique uses a special fluorescent dye. This makes it easier to see particular gene and chromosome changes.

It can help your doctor to work out which treatment you need by understanding more about your leukaemia.

Next generation sequencing (NGS)

This is a different test to pick up gene abnormalities. Genes are coded messages made of DNA that tell cells how to behave.  

With this test the doctor is looking at your complete set of DNA. This is important in AML as it can help pick up changes that could be targeted by specific cancer drugs.

Lumbar puncture

Lumbar puncture is a test to check whether leukaemia cells have spread to the fluid that circulates around the brain and spinal cord. The fluid is called cerebrospinal fluid (CSF).

This helps your doctor know if you need treatment that will get to these areas.

Tests to check for infection

AML and its treatment can weaken your immune system . This is because it stops your bone marrow from making blood cells that help fight infection. This then increases your risk of getting an infection.

You’ll have blood tests to check if you have had or have specific viruses before you start treatment. 

This is to help your doctor understand your risk of developing these viruses during treatment or the risk of them flaring up.

Your doctor usually tests for:

• human immunodeficiency virus (HIV)

• hepatitis B virus (HBV)

• hepatitis C virus (HCV)

• herpes simplex virus (HSV)

• Epstein-Barr virus (EBV)

• cytomegalovirus (CMV)

Chest x-ray

You might have a chest x-ray to check for signs of infection if you have symptoms.

An x-ray is a test that uses small amounts (doses) of radiation to take pictures of the inside of your body. They are a good way to look at bones and can show changes caused by cancer or other medical conditions. X-rays can also show changes in organs, such as the lungs.

Ultrasound scan

You might have an ultrasound to look for changes in your lymph nodes (glands) , liver or spleen . You also might have it to help find a vein for some central lines. 

An ultrasound scan is a procedure that uses high frequency sound waves to create a picture of a part of the inside of your body.

The ultrasound scanner has a probe that gives off sound waves. The probe looks a bit like a microphone. The sound waves bounce off the organs inside your body, and the probe picks them up. The probe links to a computer that turns the sound waves into a picture on the screen.

CT scan

You might have a CT scan to look for swollen (enlarged) lymph nodes and infections. Sometimes, you have a CT scan as part of your radiotherapy planning. This is for a treatment called total body irradiation (TBI). TBI is when you have radiotherapy to the whole body as part of your stem cell or bone marrow transplant . 

A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional (3D) image. 

Tissue typing tests

You have tissue typing tests if your doctor thinks that a stem cell or bone marrow transplant might be a possible treatment for you. It is to show how closely a possible stem cell or bone marrow donor’s tissue matches your own. To tissue type you have one or more of the following tests:

• a blood test

• a swab taken from the inside of your cheek (buccal swab)

• a spit (saliva) sample

Other tests you may have

You may have other tests before starting treatment. These include tests to check your heart. This is because some cancer drugs can affect the muscles of the heart. If you’re going to have one of these drugs, you need to have your heart checked before you start treatment. 

Electrocardiogram (ECG)

You might have a recording of the electrical activity of your heart. This test is called an electrocardiogram (ECG). An ECG tells your doctor a bit more about how well your heart is working. It can help the doctor decide if you need further tests.

Echocardiogram

An echocardiogram (echo) is an ultrasound of the heart. It uses high frequency waves to create a picture of your heart. Doctors can look at the structure of your heart and see how well it is working.

Treatment for AML

The results of the tests you have help your specialist build up a picture of how your AML is likely to behave. This helps guide the treatment plan they recommend.

Coping with AML

Coping with a diagnosis of AML cancer can be difficult. There is help and support available to help you and your family.