Leukemia Lymphoma Panel Laboratory Tests
A comprehensive leukemia lymphoma panel includes complete blood count with differential, bone marrow aspirate with morphologic examination, multicolor flow cytometry immunophenotyping, conventional karyotyping, FISH for specific translocations, and molecular genetic testing (PCR/NGS) tailored to the suspected disease subtype. 1, 2
Core Laboratory Components
Initial Blood Studies
- Complete blood count (CBC) with peripheral blood differential and manual smear review to identify blast cells, cellular dysplasia, or cytopenias 1, 2, 3
- Comprehensive metabolic panel including lactate dehydrogenase (LDH), uric acid, potassium, calcium, and phosphorus to monitor for tumor lysis syndrome 2, 3
- Coagulation profile (PT, PTT, fibrinogen, D-dimer) if acute promyelocytic leukemia is suspected, as it presents with disseminated intravascular coagulation in up to 90% of cases 3
Bone Marrow Examination (Essential for Leukemia)
- Bone marrow aspirate, touch imprint, cell clots, and core biopsy for morphologic evaluation with at least 30% blast cells required for acute leukemia diagnosis 1, 2
- If bone marrow aspirate is unobtainable or results in dry tap, perform cell count and morphology review on touch imprint preparation 1, 2
- Peripheral blood can substitute only if bone marrow biopsy is contraindicated or not obtainable 1
Immunophenotyping (Mandatory)
- Multicolor comprehensive flow cytometry panel performed on bone marrow aspirate (or peripheral blood if unavailable) to determine lineage: B-ALL, T-ALL, AML, or MPAL 1, 2
- For lymphoma: Pan-B and Pan-T-cell antigens with additional B- and T-cell subset antigens based on morphologic and clinical features 1
- Immunohistochemistry when flow cytometry is insufficient 1
Cytogenetic Analysis (Required)
- Conventional karyotyping must be performed on bone marrow for all acute leukemias 1, 2
- FISH studies according to disease subclassification:
Molecular Genetic Testing (Disease-Specific)
For Adult AML:
- FLT3-ITD, IDH1, IDH2, TET2, WT1, DNMT3A, TP53 for prognosis and targeted therapy 1, 2
- CEBPA, RUNX1, KIT (when core-binding factor AML diagnosed) 1, 2
- PML-RARA if APL suspected or diagnosed 1
For Childhood AML:
For B-cell ALL:
For T-cell ALL:
Lymphoma-Specific Laboratory Tests
Essential Workup for Non-Hodgkin Lymphoma
- CBC, serum LDH, comprehensive metabolic panel 1
- Hepatitis B testing (HBsAg and HBcAb) before initiating anti-CD20 monoclonal antibody therapy due to reactivation risk 1
- Hepatitis C testing for high-risk patients and splenic marginal zone lymphoma 1
- Bone marrow biopsy with or without aspirate for all lymphomas except CLL/SLL with confirmed clonal lymphocytosis by flow cytometry 1
Optional Studies (Disease-Dependent)
- β2-microglobulin for certain lymphoma subtypes 1
Cerebrospinal Fluid Analysis
For ALL and select AML cases:
- Lumbar puncture with CSF cell count and cytology examination 1, 2, 3
- Flow cytometry on CSF 1, 2, 3
- IHC study with TdT stain for ALL 1, 2
- Blast enumeration for patients receiving intrathecal therapy or AML without contraindication 1
Critical Pitfalls to Avoid
- Never rely on peripheral blood alone when bone marrow is obtainable—bone marrow aspirate is the gold standard for acute leukemia diagnosis 1, 2
- Ensure proper specimen handling: fresh tissue for flow cytometry, appropriate fixation for cytogenetics, and proper storage of nucleic acids for molecular studies 2
- Do not omit hepatitis B testing before lymphoma treatment with anti-CD20 therapy or chemotherapy, as reactivation can be fatal 1
- Perform rapid FISH for PML-RARA immediately if APL is suspected clinically, as this requires urgent specific therapy 1, 2
- Flow cytometric immunophenotyping and karyotype analysis are implemented in 99% and 96% of diagnostic laboratories respectively, making them standard of care 2