How is chronic myelogenous leukemia (CML) diagnosed?

Updated: May 23, 2021
  • Author: Emmanuel C Besa, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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The workup for chronic myelogenous leukemia (CML) consists of a complete blood count with differential, peripheral blood smear, and bone marrow analysis. Although typical hepatomegaly and splenomegaly may be imaged by using a liver/spleen scan, these abnormalities are often so obvious clinically that radiologic imaging is not necessary.

The diagnosis of CML is based on the histopathologic findings in the peripheral blood and the Philadelphia (Ph1) chromosome in bone marrow cells. Findings from the workup—in particular, the percentage of blasts in peripheral blood or bone marrow—are used to determine the phase of CML: chronic, accelerated, or blast. For more information, see Chronic Myelogenous Leukemia Staging.

Other laboratory abnormalities include hyperuricemia, which is a reflection of high bone marrow cellular turnover, and markedly elevated serum vitamin B-12–binding protein (TC-I). The latter is synthesized by the granulocytes and reflects the degree of leukocytosis.

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