The initial diagnostic work-up of adults with acute leukemia can be carried out in many community medical centers, but children with acute leukemia should usually be evaluated in a pediatric cancer center because of the sophisticated testing required.

Physical Examination 
• Enlarged lymph nodes .
• Swollen gums. 
• Enlarged liver and spleen . 
• Bruises or a small pinpoint red rash (petechiae) on the skin.

Blood and Other Tests 
• A complete blood count (CBC) usually is abnormal, but on rare occasions may be normal.

Endoscopy and Biopsy 
• The definitive test is a bone marrow aspiration and biopsy. The aspiration is performed by putting a needle 
  into the breastbone (sternum) or pelvic bone under local anesthesia.