When you visit your doctor they will probably take a full medical history, ask you questions about your general health and any illness or surgery you have had previously, give you a full physical examination and order further tests. CLL is diagnosed by using all of this information and examining samples of your blood and bone marrow in a variety of tests.
Full blood count
The first step in the diagnosis is a simple blood test called a full blood count (FBC) or complete blood count (CBC). This involves a sample of blood from a vein in your arm being sent to the laboratory for investigation. Most people with CLL have a low red cell and platelet count. Many of the white blood cells may be abnormal leukaemic blast cells and the presence of these blast cells suggests you have CLL.
Bone marrow examination
If the results of your blood tests suggest that you might have CLL, a bone marrow biopsy may be required to help confirm the diagnosis. It can also provide useful information about the likely course of the disease and to assess how well it is responding to treatment. A bone marrow biopsy involves taking a sample of bone marrow (usually from the back of the hip bone) and sending it to the laboratory for examination under the microscope. The bone marrow biopsy may be done in the haematologist’s rooms, clinic or day procedure centre and is usually performed under local anaesthesia with sedation given either by tablet or through a small drip in your arm. The sample of bone marrow is examined in the laboratory to determine the number and type of cells present and the amount of haemopoiesis (blood forming) activity taking place there.
Further testing
Once the diagnosis of CLL is made, blood and bone marrow cells are examined further using special laboratory tests. These include cytogenetic, immunophenotyping and immunoglobulin (antibody) level tests. Occasionally a lymph node (gland) biopsy is necessary to help confirm the diagnosis of CLL. This usually involves a small surgical procedure whereby an enlarged lymph node is removed. These tests provide more information about the exact type of disease you have, the likely course of your disease and the best way to treat it.
Other tests
These may be conducted to provide information on your general health and how your vital organs are functioning. These include a combination of further blood tests and imaging tests (x-rays, scans and ECG). These results will provide a baseline of your disease and general health which will be compared.