A tentative diagnosis of leukemia is made after a physical examination of the child and microscopic analysis of a blood sample. Blood tests may show too few RBCs, too few platelets, and either abnormally low or high WBC counts. Because childhood leukemia is uncommon and the signs and symptoms mimic other illnesses, diagnosis can be swift or very slow.

I took my 2-year old son Nico to the pediatrician because I thought he might have an ear infection. We were leaving with prescriptions for antibiotics, ear numbing drops, and a referral for an ENT when the pediatrician asked if Nico was always so pale. At that moment, I just knew. The doctor suggested that we check his hemoglobin via a finger stick, and it came back at 5.5. She assured me that the results of the finger stick were probably inaccurate, or that Nico might just be anemic from a recent virus. But to be safe she wanted to send us to the children’s hospital to double-check his blood via a lab draw. As I was leaving the pediatrician’s office, I asked her if the labs she had ordered would indicate if Nico had leukemia. She wanted to know how I knew. At the time I did not know how I knew, but I just knew. I cried the entire way to the hospital where Nico was diagnosed later that day.

To confirm a diagnosis of ALL, bone marrow is sampled and tested (see Chapter 9, Coping with Procedures). The bone marrow is examined under a microscope by a pathologist (a physician who specializes in body tissue analysis). A leukemia diagnosis is confirmed if more than 25% of the WBCs in the marrow are cancerous blasts. A portion of the bone marrow is then sent to a specialized laboratory that analyzes many other features of the cancer cells.

My 2 ½ year old daughter Abby was diagnosed with B-cell average risk ALL in 2007. It was mid-summer when I first had the inkling that something was wrong; she’d been struggling with sniffles and seemed clumsier, some light bruising appeared, and she was just more irritable. At first I thought that she was cranky from teething and weaning from breast milk, but by fall it was clear that Abby wasn’t herself. I felt panicked; I marched her to the doctor and said, “Something is wrong with my daughter and you need to find it now!” It was just 24 hours later that we learned Abby had cancer—her red blood cell level was dangerously low and her white blood cell count was low as well (5,800 with 33% blasts). Good science and intuition saved her.