Decorative image

Tests for childhood acute lymphoblastic leukaemia (ALL)

Your child will need a number of tests if their doctor suspects they have leukaemia. Your child might have more than one test on the same day. And they only have the tests their team think are needed.

These tests aren’t generally painful. But, your child will have to keep still for some of them.

The team caring for your child are used to helping children have these tests. They will do everything they can to prepare them, and you.

Tests could include:

  • blood tests
  • a bone marrow aspirate and trephine - this is a sample of cells from the bone marrow, and a sample of the bone marrow itself, to see if there are leukaemia cells there
  • a spinal fluid test (lumbar puncture)
  • a chest x -ray

Blood tests

A blood test to check the number of blood cells is an important test for acute lymphoblastic leukaemia.  This is called a blood count, or full blood count. A specialist doctor also checks if any of the cells look like leukaemia cells.

Other blood tests can check your child’s general health, including liver, kidneys and heart function.

How

A doctor, nurse or person specialising in taking blood (a phlebotomist) takes a small amount of blood from your child. This is usually from a vein in the back of the hand, the inside of the elbow or wrist area.

Most blood tests are over in a couple of minutes.

The specially trained staff will help your child feel as comfortable as possible. Things that can make it easier for your child include:

Local anaesthetic

The phlebotomist might use a local anaesthetic (numbing spray or cream) before the test. This should mean it’s less painful for your child, although they might still feel the needle go in.

Distraction

Distraction could be singing, counting, watching something on your mobile phone or a DVD.

Sitting with your child

Holding your child while they are having their blood test can make them feel safe and secure. And you can give them a cuddle afterwards if you’re unable to hold them during their test.

After

Your child can usually eat, drink and play as normal after a blood test.

Bone marrow tests

Your child has this test to check whether there are leukaemia cells in the bone marrow. Bone marrow is spongy tissue and fluid that is inside your bones. It makes your blood cells.

How

A doctor or specialist nurse removes a sample of bone marrow fluid (called a bone marrow aspirate). Or a small piece of bone marrow (called a trephine). Your child might have both tests at the same time.

This sample is usually taken from the back of their hip. Doctors then look at the cells or tissue under a microscope.

Diagram showing a childs bone marrow biopsy

Your child usually has this test in the daycare department of the hospital. Most children and young people have this test under general anaesthetic. Or they might have a medicine to make them feel sleepy and relaxed (sedative). This helps them lie still on the couch for the test.

Some older children might have gas and air (Entonox) instead of sedation to help them relax.

After

Your child stays on the day unit or children’s ward for a couple of hours after the test. This is so the team can be sure they have recovered and are awake enough from the sedation or anaesthetic. The nurses on the unit usually check that your child has:

  • had something to drink
  • had something to eat or some milk
  • had a wee
  • a clean and dry dressing over the site of the test

A bone marrow biopsy is a safe test. Your child’s doctor or nurse talks with you about any possible problems they might have after it. They give you a phone number to call if you have any problems after, if in doubt, give the number a call.

It’s likely your child can go home the same day, unless they are staying in hospital for other tests.

Spinal fluid test (lumbar puncture)

A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord. This is called cerebrospinal fluid or CSF. A lumbar puncture checks for leukaemia cells in the CSF. Using a special needle your child’s doctor, or specialist nurse, takes a sample of the CSF from their lower back.

Diagram of a childs Lumbar Puncture

How

Your child usually has this test in the daycare department of the hospital. Most children and young people have this test under general anaesthetic. Or they might have a medicine to make them feel sleepy and relaxed (sedative). This helps them lie still on the couch for the test.

When the area is numb, the doctor or nurse puts the lumbar puncture needle in through the skin. It goes into the small of the back and into the space around the spinal cord. They might feel some pressure and a slight soreness when the needle goes in.

Once it's in the right place, the fluid drips out into a pot. This only takes a few seconds. The doctor or nurse takes the needle out and puts a dressing or plaster on your child’s back.

After

Your child’s team will talk you through the benefits and risks of having a lumbar puncture. There is a risk of bleeding and infection but this is very rare.

You should contact your hospital if your child is at home after a lumbar puncture and they get symptoms such as:

  • a severe headache
  • being sick
  • their eyes are sensitive to bright light
  • tingling or numbness in their legs

Your nurse will tell you what symptoms to look out for and who to contact if you have any problems at home.

It’s likely your child can go home the same day, unless they are staying in hospital for other tests.

Chest x-ray

X-rays use high energy rays to take pictures of the inside of your body. Chest x-rays can show:

  • fluid
  • signs of infection
  • an enlarged heart
  • enlargement of the lymph glands in the chest, where leukaemia cells have collected

How

There is no special preparation for an x-ray. Your child usually has a chest x-ray standing up against the x-ray machine if they are old enough to stand. They have it lying on the x-ray couch if they are younger or unable to stand.

Photograph of Child having a chest x-ray

X-rays are painless and quick. Your child won’t feel or see anything. You are usually able to stay in the room when your child is having their x-ray. You need to wear a lead apron to protect you from the small amount of radiation.

Your child’s specialist makes sure the benefits of having an x-ray outweighs the risks of the small amount of radiation.

After

Your child can usually eat, drink and play as normal after a chest x -ray.

Other tests

Your child might have other tests depending on what symptoms they have. These tests might include:

  • a CT scan
  • an MRI scan
  • an ultrasound scan
  • a heart scan – to test the strength of your child’s heart using sound (echocardiogram)

What next?

Most people read our information about treatment for ALL.

Last reviewed: 
11 Jul 2018
  • Cancer in Children – Clinical Management
    MCG Stevens, HN Caron and A Biondi (Editors)
    Oxford University Press, 2012

  • Acute lymphocytic leukaemia 
    BMJ Best Practice
    Accessed January 2018

  • Pediatric Oncology Nursing – Advanced Clinical Handbook (2nd Edition)
    D Tomlinson and N E Kline (Editors)
    Springer, 2010

  • Childhood Acute Lymphoblastic Leukemia
    A Vora (Editor)
    Springer International, 2017

Information and help

Dangoor sponsorship

About Cancer generously supported by Dangoor Education since 2010.