Investigations in ALL

Laboratory finding in ALL include:

• complete blood count with differential
  • severe anaemia (Hb < 8 g/dl) - seen in around 28%
  • severe granulocytopenia (neutrophils <0.5 × 10^9/l) - in 22%
  • severe thrombocytopenia (platelets <25 × 10^9/l) - in 30%
  • hyperleukocytosis - total white blood cells >10 ×10^9/l - in 59%, and >50 × 10^9/l in 28%
    • detectable circulating blast cells in 92% of cases
• renal function
  • hyperuricaemia
• clotting tests and fibrinogen concentration - to screen for disseminated intravascular coagulation.
• LDH levels - usually elevated
• screen for evidence of active infection (1,2).

Bone marrow biopsy and aspirate for:

• cytogenetic analysis
• immunophenotyping - it is important to differentiate between T-cell, mature B-cell and B-cell precursor phenotypes for therapeutic purposes (3)

Reference:

• 1. National Cancer Institute at the National Institutes of Health. General Information About Adult Acute Lymphoblastic Lekemia (ALL)
• 2. Bassan R et al. Adult acute lymphoblastic leukaemia. Crit Rev Oncol Hematol. 2004;50(3):223-61. 3. Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet. 2008;371(9617):1030-43.