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Some of the CML patients might not show a specific symptom during the diagnosis. It can be detected during a routine check or a test for some other medical condition.
The symptoms and findings related with CML are prone to be surface over time. Some of these findings are;
- Fatigue,
- Experiencing shortness of breath while doing chores,
- Pale skin color,
- Night sweats,
- Weight loss,
- Intolerance to increase in temperature,
- Frequent infections,
- Excessive bleeding
- Loss of appetite,
- Stretchy feeling in the upper abdomen area (due to increased spleen size)
However the symptoms stated above can be seen for many other diseases. The fact that you have these symptoms in no way indicates you have CML.
In order to diagnose CML the patient’s detailed history should be checked and a physical should be done. The request for lab tests from a physician who specializes in this area (hematology) make up the second important phase on the way to diagnosis.
The preliminary tests your physician will request would be a blood count and a peripheral smear. Blood counts (hemogram) on CML patients might show decrease in red blood cells (anemia). The amount of white corpuscles (leukocytes) might show as either higher than normal or abnormally increased. Blood placelets can either be higher or lower than normal.
For the peripheral smear a drop of blood is drawn from your fingertip and dropped onto a microscopic slide. Then it is painted with special paints. This slide is observed under light microscope. CML patients’ blood sample shows the developing cells called Blast. These cells are not found in healthy people’s blood samples.
Some findings related to CML might now show in blood samples. A small sample retrived from the bone marrow sheds the light on the way for the clinic staff. is rather a short procedure.
Marrow cells are observed under microscope (cytogenetic analysis). The chromosome map which is called Kayrotyping will show the Philadelphia chromosomes.
Plus the FISH (Fluorescence in situ hybridization) test enables the finding of the Philadelphia chromosome which was invisible during the cryogenetic analysis.
When FISH or the standart Karyotyping is inadequate to present an accurate analysis PCR test is done in order to detect CML cells. This test can detect even very small amounts of CML cells in a blood or bone marrow sample.
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Bone marrow examination is a significant method for evaluating hematologic diseases.
It enables the diagnosis, phasing and evaluating the ongoing treatments for diseases such as leukaemia, lymphoma and multiple myelom.
Cytopenia (the decrease red corpuscles, white corpuscles and placelets in charge of clotting, basically the cell elements found in blood), thrombosis (increase in thrombocytes), Leukocytosis (a raised white blood cell count), anemia (decrease in red blood cells) and iron levels can be evaluated.
Bu using Bone Marrow Aspiration and Biopsy various bacteria surrounding the bone marrow, funfal infections (micro bacteria, leishmania) and storage diseases (Gaucher’s, Niemann-Pick) could be diagnosed.
The aspirate (the liquid part of the marrow) obtained afthe the procedure is used im cytological evaluation. Tissues are observed in pathology labs. Cytogenetical, microbiological and molecular observations, immunohistochemical analysis, flow cytometry are among the cmoplicated tests which can be used for diagnosis.
Before the procedure a full blood count, peripheral smear and clotting tests (aPTT/PT-INR) are required.
Malignancy, infections and hemorrhage history is clinically essential for the physician.
Posteriror iliac crest (superolateral margin of the greater pelvis) could be used for the procedure.
The subject area should be cleaned by using aseptic techniques (Betadine solution).
The physician in charge should put on surgical gloves and apply local anesthesia (Citanest).
The patient is given IV Dormicum to induce sedation.
With the aid of the aspiration syringe the bone sample and marrow aspirate are withdrawn.
Pain killers (Minoset) could be used after the procedure.
After the procedure you may need to lay on your back for approxiamately 30 to 60 mins.
After 24-36 hours bandage can be removed for bathing.
The most common complication is hemorrhage in the area. This is usually dealt by applying pressure. Also there could be very rare complications such as the needle breaking or infections. All of these are encountered in only 5 or 7 patients out of 10.000 (0.05-0.07%).
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CML is described in three phases.
- Chronic Phase: Most patients awaiting diagnosis are in the chronic phase. In this phase the symptoms and findings related with CML are pretty mild. White corpuscles are able to fight off infections. People in the chronic phase could go about their normal lives after supplementary treatment.
- Accelerated Phase: The blood tests of the patients in this phase could reveal anemia, increase/decrease in white corpuscles (leukocytosis/leukopenia) and decrease in blood placelets (thrombocytopenia). People in the accelerated phase can feel fatigue and sick. Due to the raise in blast cells, spleen may increase in size.
- Blastic Phase: CML patients in the Blastic Phase have significantly high blast cells in their bone marrow and blood. This leads to the decrease of red corpuscles and blood placelets. Petients in this phase are more prone to infections. Bleeding gums, blood in urinary tract and faeces are likely. Fatigue, exhaustion, shortness of breath, bone aches are possible complaints.
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