Acute Lymphoblastic Leukemia (ALL) Testing and Diagnosis

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Acute lymphoblastic leukemia (ALL) is a cancer of the bone marrow and blood. If your physician thinks you may have ALL, tests can help them learn more about your blood and bone marrow.

Your test results also help your physician tell which subtype of ALL you have. Knowing your subtype and the features of your leukemia cells helps your physician plan your treatment.

Take Charge of Your Health

Talk to your primary care provider if you have symptoms that you think may be acute lymphoblastic leukemia. UW Medicine Primary Care can help you get started. Learn about Fred Hutch's relationship with UW Medicine. 

How ALL Is Diagnosed

In people with ALL, immature blood cells called lymphoblasts multiply out of control and build up in the bone marrow and blood. Your provider will likely ask you about your personal health history as well as family health history along with doing a physical exam. In addition, there are tests to help diagnose ALL.

Tests to Diagnose ALL

If your physician thinks you may have ALL, you will likely have blood tests and a bone marrow biopsy. These tests help confirm the diagnosis, identify your ALL subtype and guide your treatment.

Blood Tests

Blood tests can show if your blood cells are healthy or if leukemia cells may be present. Common blood tests include:

  • Complete blood count (CBC): Measures red blood cells, white blood cells and platelets.
  • Blood chemistry tests: Check how your organs are working.
  • Peripheral blood smear: Looks at blood cells under a microscope to check for leukemia cells.

Bone Marrow Tests

A bone marrow aspiration and biopsy removes a small sample of bone marrow, usually from your hip bone. The sample is examined to confirm ALL and learn more about the leukemia cells.

Specialized Lab Tests

Additional tests look for changes in chromosomes and proteins on leukemia cells. These results help identify your ALL subtype, including Philadelphia chromosome-positive (Ph+) ALL, and help your care team choose the best treatment.

Tests to See if ALL Has Spread

If needed, you may also have tests to see whether leukemia has spread to your brain, spinal cord or other parts of your body. These may include a spinal tap (lumbar puncture), chest X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging).

Confirming Your Diagnosis

Most of our new patients have already had a blood test or bone marrow test that shows they have ALL and which subtype it is. A Fred Hutch hematopathologist will check your tests before your first appointment to see if they agree with the test results.

Our hematopathologists may run more tests to confirm your diagnosis or to narrow down your subtype. They will give the results to your Fred Hutch physician, who will explain your diagnosis and what it means.

Dr. Ryan Cassaday in a shirt and tie with a black sweater
Dr. Ryan Cassaday is a hematologist-oncologist and researcher who cares for patients with leukemia at Fred Hutch.

Why Choose Fred Hutch for Acute Lymphoblastic Leukemia Care

Treatment for ALL is complex, so it’s important to be treated at a specialized center with expertise in ALL. Fred Hutch hematologist-oncologists offer comprehensive ALL care, including advanced treatments and new options that may only be available through clinical trials. Our deep experience means the best treatment plan for you.