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When acute lymphoblastic leukemia in children is suspected, a number of tests are performed to evaluate the child. The initial test will be a blood test called the complete blood count (CBC). A pediatrician or family doctor may order blood tests before referring a child to a specialist called a pediatric hematologist or pediatric oncologist. Those tests are often repeated when the child sees the specialist.
Although leukemia cells may be found in the blood, most commonly, the diagnosis and classification of leukemia are confirmed by looking at a sample of bone marrow under the microscope. This sample is obtained by performing a bone marrow aspirate.
Since ALL is a cancer of the blood, it is not "staged" in the way solid tumors are. By nature, leukemia is widespread at diagnosis, but this does not affect successful treatment. However, leukemia cells can also be present in the spinal fluid, which is known as Central Nervous System (CNS) disease. A special test known as a spinal tap or lumbar puncture will be performed to obtain fluid for examination.
Early studies showed there was an increased risk of ALL when a baby was x-rayed while in its mother's womb. Today, however, researchers believe that x-rays during pregnancy cause few, if any, cases of ALL because pregnant women are not x-rayed often and the amount of radiation used in x-rays is much, much lower than it was years ago. Children who receive x-rays to diagnose a medical condition, such as a broken bone or tooth decay are NOT at increased risk to develop ALL.
Most studies show that babies with high birth weight (more than 4,000 grams, which is 8 lbs, 8 oz.) are at slightly increased risk of developing ALL. Currently, it is not known why high birth weight increases the risk of ALL.
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