Questions to ask about AML
Preparing a set of questions for discussion at your consultation will help you understand what to expect and what treatments may be necessary upon diagnosis.
Questions About My Diagnosis
- What is my diagnosis?
- What tests should I have to confirm my diagnosis?
- What is AML, and how is it different from other types of leukemia?
- What is my prognosis?
- Are there other conditions that mimic this condition?
- Are there medications that give a false reading for this diagnosis?
- Should I get a second opinion before any treatments?
Questions About My Treatment
- Are you an oncologist with experience in treating the specific blood cancer diagnosed?
- Are you experienced and knowledgeable about all treatment options?
- What is my best treatment option and why? What are the side effects?
- How long will I be undergoing treatment?
- How will I know if the treatment is working?
- Will I need to be in the hospital for treatment?
- Who will be part of my health care team, and what does each doctor do?
- Who will be leading my treatment plan?
- Is there a clinical trial available? How do I find out about it?
Questions About My Lifestyle & Family
- What type of follow-up will I need?
- Is this hereditary?
- Will I still be able to work?
- Can I have sexual intimacy?
- Are there any limitations on my activities?
- Will this affect my fertility?
- Is there a special diet I should follow?
- Are there support groups?
- Do you have brochures or information about this?
- Is this covered by my insurance?
Diagnosis of Acute Myeloid Leukemia
The doctor will review your medical history and give a comprehensive examination, looking for bleeding, bruising, and infection as well as giving close scrutiny to the liver, spleen, lymph nodes, eyes, and skin.
Lab tests used to Diagnose and Classify AML
The following tests help diagnose AML and/or determine the subtype.
Blood tests are done initially to look for leukemia by assessing red cells, white cells, and platelets. A tourniquet is placed around the arm, an antiseptic is used to swab the skin over the vein, and an needle is inserted into the vein. Suction is applied to get the appropriate amount of blood, the needle is then removed, the tourniquet is released, and a pressure dressing is applied.
Complete blood count (CBC) with peripheral blood smear measures amounts of various cells in the blood, and the differential evaluates the number of different types of white blood cells. A blood sample is evaluated under a microscope in the peripheral blood smear, showing changes in the number and appearance of different types of blood cells. This often helps in diagnosing leukemia.
Bone marrow samples
Since leukemia originates in the bone marrow, it is crucial to test at this site. Bone marrow samples are retrieved by two tests, which are typically performed at the same time:
- Bone marrow aspiration- you lie on an exam table, and the doctor will clean the skin over the hip or sternum with an antiseptic and numb the area by injecting a local anesthetic. This may cause burning or a brief stinging. A thin needle is inserted into the bone, and a syringe is used to suck out a small amount of liquid bone marrow, which is sent to the lab for analysis. Pressure dressing is then applied.
- Bone marrow biopsy- typically done right after aspiration, a small piece of bone and marrow is retrieved using a slightly larger needle that’s pushed down into the bone. This may cause some pain briefly. Once the biopsy is done, the needle is removed, and pressure is applied to the site to prevent bleeding.
Although these tests are done for diagnosis, they may be repeated at a later date to determine if leukemia is responding to treatment.
The key is determining if the cells appear mature or immature. The most immature cells are called myeloblasts. The percentage of blasts is important to know. At least 20% blasts in the marrow or blood is needed for an AML diagnosis.
Cytochemistry: cells are exposed to chemical stains/dyes that only react with certain leukemia cells. The color changes are viewed under a microscope, which help in verifying what types of cells are present. The stain causes granules of most AML cells to appear as black spots.
Flow cytometry and immunohistochemistry: samples of cells are treated with antibodies (proteins that stick to other proteins on cells). For cytometry, a special machine is used, but with immunocytochemistry, the antibodies are seen through a microscope.
These tests classify leukemia cells by the antigens (substances on their surfaces). This is helpful in AML classification (i.e. immunophenotyping).
Chromosome Tests/ Cytogenetics: cells are viewed under a microscope to see any chromosomal abnormalities. AML cells sometimes have chromosomal changes.
Some chromosomal changes cannot be detected through a microscope, and the following test is also done to look for chromosomal changes.
Polymerase chain reaction (PCR): a sensitive test that detects gene and chromosome changes too small to be found.
Spinal Tap or Lumbar Puncture: checks for spread of AML into the area around the brain and spinal cord. This is usually done only if symptoms arise that suggests this area is affected.
You are asked to lie on your side or sit curled with elbows on knees. The doctor numbs an area of skin on the lower part of the back over the spine. A small hollow needle is inserted between the bones of the spine into the area around the spinal cord, and some fluid is sucked out with the syringe. The needle is then removed, and pressure is applied to prevent additional fluid leakage.
Radiographic imaging is not helpful in making a diagnosis since leukemia doesn’t typically form tumors. X-rays are done when infections or other problems are suspected.