An Acute Leukemia Panel is a comprehensive set of tests used to diagnose and classify acute leukemia, a rapidly progressing cancer of the blood and bone marrow. This panel helps distinguish between different subtypes of leukemia, which is essential for determining the most effective treatment plan. The panel typically includes a combination of the following diagnostic tools:

1. Complete Blood Count (CBC) with Differential:

• Measures the number of red blood cells, white blood cells, and platelets.
• Identifies abnormal counts or immature blood cells (blasts) indicative of leukemia.

2. Flow Cytometry:

• A key tool for immunophenotyping, this test detects cell surface markers to differentiate between acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
• Helps determine the specific subtype of leukemia by identifying unique antigen patterns on the surface of cells.

3. Cytogenetic Analysis (Karyotyping):

• Examines the chromosomes in bone marrow cells to identify specific genetic abnormalities associated with different leukemia subtypes.
• Common translocations or mutations, such as t(9;22) BCR-ABL (Philadelphia chromosome) or t(15;17) in acute promyelocytic leukemia (APL), are crucial for diagnosis and prognosis.

4. Fluorescence In Situ Hybridization (FISH):

• A more sensitive test that can detect specific chromosomal abnormalities not easily seen in standard karyotyping.
• Used to confirm the presence of genetic mutations like BCR-ABL, MLL rearrangements, or RUNX1-RUNX1T1.

5. Molecular Genetic Testing:

• Identifies mutations at the DNA level, such as FLT3, NPM1, or TP53, which have implications for prognosis and targeted therapies.
• Polymerase chain reaction (PCR) and next-generation sequencing (NGS) are commonly used techniques.

6. Bone Marrow Aspiration and Biopsy:

• Involves the extraction of bone marrow to examine cell morphology under a microscope and confirm the presence and percentage of leukemic blasts.
• Essential for the definitive diagnosis and classification of the type of leukemia.

7. Additional Biochemical Tests:

• Lactate dehydrogenase (LDH) levels and other markers can indicate the cell turnover rate and disease burden.
• Uric acid and other metabolic indicators may be elevated due to rapid cell breakdown.

Purpose and Importance:

• The acute leukemia panel is crucial for differentiating between subtypes of leukemia, which can vary significantly in treatment response and prognosis.
• Accurate classification helps guide treatment plans, including chemotherapy, targeted therapy, or stem cell transplantation.
• Monitoring for minimal residual disease (MRD) is also facilitated by these tests, aiding in treatment effectiveness and relapse prediction.