Acute leukemia starts relatively acutely with development of symptoms within a few days to weeks, sometimes months. Untreated, the disease usually has a stormy course and the patient may die of infection or bleeding in a few weeks or months.
Chronic leukemia has a more insidious initial phase than acute leukemia and is often discovered coincidentally during a routine check or examination and treated for other illnesses.
- Determine clinical growth rate of the disease
- General status emphasizing pathological node tumors and hepato/splenomegaly
- Record whether there have been B symptoms (weight loss, fever, pathological night sweats) or other general symptoms
- Urine stix
- Pulmonary X-ray is taken routinely for all types of leukemia
The cornerstone of the diagnosis is the morphological test using May Grünwald/Giemsa-stained blood and bone marrow smear (possibly supplemented with a bone marrow biopsy).
Supplementary examinations such as cytochemical changes and immunophenotyping are necessary in cases of doubt where an exact diagnosis is decisive for specific treatment. If the treatment is aggressive and potentially offers a cure, a correct diagnosis is decisive for the future of the patient.
A cytochemical examination of bone marrow cells and to an increasing degree molecular genetic testing, are important for assessment of the patient's prognosis and choice of treatment.
For suspicion of acute leukemia in a patient under 60–70 years, the regional hospital should be contacted immediately for transferal of the patient, for immediate medical work-up, and to start treatment.