Leukemia Lab Tests and health information

Order your leukemia tests to screen for abnormal levels of red or white blood cells or platelets — which may suggest leukemia and may also show the presence of leukemia cells. Take control of your health and get tested with Ulta Lab Tests.

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A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Before ordering this test consider The Complete Blood Count (CBC) with Differential and Platelets Blood Test (Test # 6399) which is a better value.

In Quest's internal studies of more than two thousand patient samples, no significant abnormalities were detected with manual differentials associated with test code 20253 that were not otherwise identified thru the test code 6399 CBC Reflex cascade.

This test is a CBC reflex test and it will include the components of the CBC (Includes Diff/PLT) with Smear Review based upon the test results of the following analytes if are above or below ranges as outlined in the test.

  • WBC 
  • Hemoglobin 
  • Hematocrit 
  • Platelet 
  • MCV 
  • MCH 
  • MCHC 
  • RBC 
  • RDW 
  • Relative Neutrophil % 
  • Relative Lymphocyte % 
  • Relative Monocyte % 
  • Eosinophil 
  • Basophil 
  • Platelet 

NOTE: Only measurable biomarkers will be reported.

Acute Myeloid Leukemia Prognostic Panel (Normal Karyotype)

Clinical Significance

This testing, consisting of FLT3, NPM-1, and CEBPA, is recommended in the NCCN guidelines for determination of AML risk status in patients with cytogenetically normal AML. The presence of CEBPA gene mutations is associated with increased disease-free survival and overall survival. Mutations in NPM1 gene is a predictor of favorable prognosis and good response to induction chemotherapy. The presence of (FLT3) internal tandem duplication is associated with short disease-free survival.

Most commonly utilized test to monitor characteristic response to infection. Diagnostically useful for diseases such as leukemia, leukocyte disorders, as well as monitoring therapy of these diseases.

A screening test for various disease states to include leukemia and inflammatory processes.

To detect AML1-ETO t (8;21) fusion transcript that is common in acute myeloid leukemia (AML) M2 subtype. Besides initial diagnosis and prognosis evaluation, this assay is intended to monitor the clinical course and effectiveness of therapy of Minimal Residual Disease (MRD). It may be valuable to monitor the disease trend in the same patient and predict the approaching relapse

This assay is used to monitor exposure to arsenic, wellness, and therapy during treatment of chronic myelocytic leukemia.

Calcitonin concentration is increased in patients with medullary thyroid carcinoma. Calcitonin concentrations may be used to monitor disease.

This Real-Time Quantitative (Reverse Transcription Polymerase Chain Reaction) for the amplification of CBFB/MYH11 fusion transcript can be used to detect the chromosome aberration of inv (16) or t (16;16). It can be used to detect Minimal Residual Disease (MRD) and assess the risk for disease relapse in inv (16) or t (16;16) Acute Myeloid Leukemia (AML).

CH50 is a screening test for total complement activity. Levels of complement may be depressed in genetic deficiency, liver disease, chronic glomerulonephritis, rheumatoid arthritis, hemolytic anemias, graft rejection, systemic lupus erythematosis, acute glomerulonephritis, subacute bacterial endocarditis and cryoglobulinemia. Elevated complement may be found in acute inflammatory conditions, leukemia, Hodgkin's Disease, sarcoma, and Behcet's Disease.

Clinical Significance

FISH, B-Cell Chronic Lymphocytic Leukemia Panel - This test is performed to detect the rearrangements of 6q21(SEC63),6q23(MYB),ATM(11q22.3),centromere 12(D12Z3), 13q14.3(DLEU),13q34(LAMP1) and TP53(17p13.1) regions,by FISH (fluorescence in situ hybridization). This assay is useful for prognostic assessment for chronic lymphocytic leukemia/ small lymphocytic lymphoma(CLL/SLL).

A complete blood count used as a screening test for various disease states to include: Anemia, leukemia and inflammatory processes.

A complete blood count is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

HTLV-I/II Antibody, with Reflex to Confirmatory Assay



If HTLV-I/II Antibody is positive, HTLV-I/II Antibody, Confirmatory Assay will be performed at an additional charge (CPT code(s): 86689)


Clinical Significance

HTLV-I is associated with adult T-cell lymphoblastic leukemia and B-cell chronic lymphocytic leukemia. HTLV-II is less common and is associated with neoplasias of the CD8 T lymphocytes. Blood donor screening began in 1998.

Monoclonal increases in IgG or IgA are often associated with diseases such as multiple myeloma, lymphomas or leukemia. A monoclonal increase in IgM is commonly associated with Waldenström's macroglobulinemia.

False elevations of potassium may be due to hemolysis or rupture of platelets during coagulation process. The use of plasma potassium levels should be limited to those patients with spuriously elevated or depressed potassium levels due to blood samples left at room temperature, in patients with chronic lymphocytic leukemia with very high WBC counts (false decline), and those with thrombocytosis (increased platelets) with counts in excess of one million (false elevation).

A complete blood count used as a screening test for various disease states to include: anemia, leukemia and inflammatory processes

CD20 antigen is expressed on the surface of >90% of B-cell non-Hodgkin's Lymphomas (NHL). Binding to CD20 antigen is necessary for the antitumor effect of Rituxan®.


6-Thioguanine (6-TG), 6-Methylmercaptopurine (6-MMP)

Patient Preparation 

trough specimen is required (within 1 hour prior to the next dose)

Reference Range(s)


6-TG 235-400 pmol/8x10(8) RBC
6-MMP <5700 pmol/8x10(8) RBC


Clinical Significance

6-Mercaptopurine (Purinethol) and its imidazolyl derivative, Azathioprine (Imuran), are immunosuppressive drugs. 6-Mercaptopurine (6-MP) is indicated for remission induction and maintenance therapy of acute lymphoblastic leukemia (ALL). Azathioprine is indicated as an adjunct for the prevention of rejection in renal allograft (kidney transplant) patients, for the management of rheumatoid arthritis, and for the management of inflammatory bowel disease.
Azathioprine is cleaved to 6-MP. 6-MP is metabolized via a series of enzymatic steps to 6-thioguanine nucleotides (6-TGNs), to 6-methyl-mercaptopurine (6-MMPNs) by the enzyme thiopurine methyltransferase (TPMT), and to 6-thiouric acid by the enzyme xanthine oxidase (XO). TPMT enzyme activity has large inter-individual variations which affect the efficacy, toxicity and variability of the treatment. Therapeutic drug monitoring of 6-MP metabolites (6-TGNs and 6-MMPNs) in erythrocytes is recommended to assist therapy, particularly in combination with TPMT enzyme activity or mutation analysis.

Clinical Significance

Tryptase concentrations are increased with immediate hypersensitivity (anaphylaxis), acute allergen challenge, and mastocytosis.

Most Popular
Serum uric acid measurements are useful in the diagnosis and treatment of numerous renal and metabolic disorders, including renal failure, gout, leukemia, psoriasis, starvation or other wasting conditions, and in patients receiving cytotoxic drugs.

Leukemia is a form of cancer that affects the blood or blood making tissues. Bone marrow is found in the spongy regions of the bones, usually pelvis bones, sternum, vertebrae, and ribs. It is tasked with making early blood-forming cells, white blood cells, platelets, and the precursors of red blood cells. These precursors grow until they mature in the bone marrow and then released into the bloodstream. 

Well, blood cancer develops when the bone marrow forms unusual blood cells, which start to divide out of control. More often than not, this form of cancer affects the white blood cells, but it can affect other types of blood cells too. White blood cells play a significant role in fighting infections in the body, but when leukemia affects them, they become leukemia cells, and they fail to die like normal cells. Instead, they garner and crowd out the normal cells. This includes normal white blood cells, platelets, and red blood cells, as well as their precursors found in the bone marrow. This, as you can expect, leads to an array of problems, including easy bruising and bleeding, failure to get adequate oxygen to body tissues, and an increased risk of infections. 

Leukemia cells, over time, can spread through the bloodstream and blood, sometimes referred to as a liquid tumor. This is where they divide, occasionally forming solid tumors and also doing damage to body organs. Which organs sustain damage depends on the type of blood cancer. For instance, the liver, lymph nodes, and spleen may become swollen and enlarged as a result of the accumulation of the abnormal cells. In other cases, leukemia cells reach the CNS (or central nervous system) and garner in the cerebrospinal fluid. 

In the U.S alone, almost 50,000 people are diagnosed with leukemia each year, and over 23,000 die of the condition. This type of cancer usually affects adults older than 55 years, but it is also the most common form of cancer in teens and children younger than 15. The cause of this condition is not well known, but exposure to cancer-causing chemicals, radiation, and anticancer drugs have been seen to increase the risk of developing it. Some cases are due to rare viral infections and genetic disorders in others. 

Types of Leukemia 

There are several types of blood cancer. Each type is classified based on if it grows rapidly and becomes lethal fast if not treated (this is also referred to as acute blood cancer), or grows gradually (or chronic blood cancer) and also the type of white blood cell that cancer started. 

There are two categories of early blood-forming cells that produce white blood cells (or immature precursors): 

  • Myeloid Precursor Cells: These produce red blood cells and a number of white blood cells called granulocytes. The latter move in the bloodstream fighting infections through killing and digesting the harmful bacteria. 
  • Lymphoid Precursor Cells: These grow and mature into lymphocytes, a kind of white blood cell that can be found in both the lymphatic and blood circulatory system. Their role is to coordinate your body’s immune response, and a huge number of them produce antibodies. 

As such, blood cancer can be classified as Lymphoid or Myeloid. There is another type of cancer that affects the lymphocytes, but it does not occur in the bone marrow, but the lymphatic system instead. It is referred to as lymphoma, and it is diagnosed and treated rather differently. 

The Four Primary Leukemia Categories Are: 

  • ALL (or Acute Lymphocytic Leukemia) – This type of cancer tends to develop from lymphocytes yet to mature. Lymphoid leukemia cells found in acute lymphocytic leukemia are known as leukemic lymphoblasts. This form of cancer can develop quickly, and when not attended to, it can be lethal in just a few months. The cancer cells build up in the blood and bone marrow. Cancer can ideally spread to the lymph nodes and, ultimately, CNS. 

One form of acute lymphocytic leukemia is caused by two chromosome pieces breaking and switching places, referred to as translocation. This leads to an altered, fused gene on chromosome 22, referred to as the Philadelphia chromosome. This gene makes a protein that functions abnormally, leading to the overproduction of immature lymphoid cells. This form of cancer is referred to as Philadelphia chromosome-positive acute lymphocytic leukemia. 

Untreated acute lymphocytic leukemia can result in poor immunity, easy bleeding and bruising as well as anemia. The condition is common in children compared to adults. 

  • CLL (or Chronic Lymphocytic Leukemia) – This form of cancer starts in immature lymphocytes, but the leukemic cells occur in mature lymphocytes. Compared to other forms of leukemia, it grows gradually and doesn’t call for frequent treatment. It can remain stable for years, but there’s a faster-developing form of chronic lymphocytic leukemia that tend s to block normal cell production and calls for treatment. Individuals with this form of cancer have enlarged lymph nodes, known as lymphadenopathy, autoimmunity like autoimmune hemolysis, immunoglobulin deficiencies that result in poor immunity as well as an enlarged spleen. This condition primarily affects older adults. 
  • AML (or Acute Myeloid Leukemia) – This is a rapidly growing form of cancer whereby the immature myeloid cells divide continually in the bone marrow and can replace it with immature and abnormal white blood cells. When this form of cancer is untreated, it can result in poor immunity, infections, anemia, as well as easy bruising and bleeding. AML is usually common in older adults, but it can ideally occur in young adults and kids. Acute promyelocytic leukemia is a subtype example of AML that’s treated differently from other AML forms and usually has better results. 
  • CML (or Chronic Myeloid Leukemia) – This is another slowly-developing form of blood cancer. Individuals with CML usually have no symptoms initially but are usually diagnosed during a routine physical or blood test. When symptoms occur, they tend to be similar to common, less serious conditions and include stomach discomfort due to an enlarged spleen, less energy, pale skin and weight loss that’s unaccounted for. Similar to Philadelphia chromosome-positive acute lymphocytic leukemia, CML is caused by an abnormal gene (BCR/ABL) on chromosome 22. If left unattended, CML can result in poor immunity, anemia, overly enlarged spleen, and excessive bruising and bleeding. The condition is prevalent in adults, with seniors over 65 experiencing a higher risk. CML rarely affects younger adults and children, and it can be treated with drugs known as tyrosine kinase inhibitors. 

The Signs and Symptoms of Leukemia 

Blood cancer signs and symptoms tend to vary depending on the type. The acute type may cause signs and symptoms related to not having adequate normal blood cells.

The signs and symptoms include: 

  • Shortness of breath, pale skin, and weakness due to anemia (a lack of red blood cells). 
  • Fever & infections as a result of inadequate infection-fighting white blood cells. 
  • Bruising and bleeding as a result of a lack of platelets. 

Other signs & symptoms may include headaches, vomiting, seizure and confusion, joint and bone pain, night sweats, unexplained weight loss, and enlarged spleen, kidneys, lymph nodes, and/or testicles. 

Chronic leukemia, as mentioned earlier, grows gradually, and so, it may not have early signs and symptoms. It may, however, cause milder forms of the symptoms prevalent in acute blood cancer. Chronic leukemia can be found by chance during routine checkups before even any symptoms are visible. Some cases may need to be monitored for several years before treatment is needed, while others can be more aggressive. If the cancer cells start to divide more rapidly, they can lead to a blast crisis or progression to acute leukemia. This results in the production of just immature cells and worsening the condition.

Symptoms of chronic leukemia include: 

  • Feeling rundown or tired 
  • Loss of appetite and unexplained weight loss 
  • Breath shortness during normal activity 
  • Discomfort or pain in the upper left side of the stomach. Usually caused by an enlarged spleen. 
  • Pale skin 
  • Fever 
  • Bruising and bleeding easily 
  • Night sweats 

Leukemia Lab Tests 

There are several lab tests that can be used to diagnose blood cancer, determine the type as well as monitor the treatment’s effectiveness. After an effective treatment or remission, testing can also be done to check whether cancer has returned. 

The General Blood Tests Include: 

CBC (or Complete Blood Count) & WBC Differential 

These are routine tests that assess the cells circulating in the bloodstream. They count the number of cells and check the maturity as well as the proportion of the varying cells. These blood tests can give the initial indication of blood cancer. Abnormal results, like a reduced number of red blood cells and increased white blood cell count, can be as a result of leukemia but an array of chronic or temporary conditions. However, immature blood cell precursors or blasts are usually not seen in blood, and so, if present, leukemia is most likely present, and a follow-up test will be ordered. The CBC and WBC differential tests are ideally essential in monitoring the effectiveness of treatment and also the detection of recurrence. 

Blood Smear 

This is a test that is usually used to follow up the above tests with abnormal red blood cells, white blood cells, or platelets. It can also be ordered when the CBC results are unclear. In this test, a blood drop is smeared on a microscope slide and assessed for immature cells or cells with abnormal shapes, appearance, or size compared to normal ones. 

Bone Marrow Aspiration or Biopsy 

If leukemia is suspected, a bone marrow aspiration, biopsy, or both can be conducted in order to take a closer look at the marrow tissues. A specialist (pathologist) examines the sample using a microscope and evaluates the size, appearance, shape, and number of each cell type and also the proportion of mature and immature blood cells. If blood cancer is present, the next step is to determine the type and severity of the condition. This test ideally helps set a baseline for the bone marrow cells, with an attempt to see how well they respond to treatments. 

Some select tests usually include: 

  • Lumbar Puncture (or Spinal Tap) & Cerebrospinal Fluid Analysis – If blood cancer is detected in the bone marrow, a spinal tap can be done in order to help determine if cancer has spread to the cerebrospinal fluid and CNS. If cancer cells are found in the cerebrospinal fluid, additional treatment such as direct injection of a drug into the CSF may be needed. 
  • Phenotyping or Immunophenotyping by Cytometry Flow – This is a test that can help detect leukemia and also the type. 
  • Chromosome Analysis or Karyotyping – This is a cytogenetic test used to map the 46 chromosomes in cells, with the aim of detecting changes in size, number, or arrangements associated with leukemia. 
  • Molecular Testing – The malfunction of cells that control cell growth and development is one of the factors that lead to uncontrolled cancer cell growth. The malfunctions can stem from DNA abnormalities, like mutations. Laboratory tests detect the abnormalities related to some types of blood cancer. These can help guide treatment and determine the cause of the condition and even assess the effectiveness of the treatment. 

Fluorescent In Situ Hybridization 

This is another cytogenetic test that looks for alterations in chromosomes resulting from genetic variations. This test is more sensitive than chromosome analysis. An abnormal gene segment in this test is made to fluoresce or light up when bound by a particular probe. The test helps diagnose varying types of blood cancer that look similar but have