The treatment team, after taking a thorough medical history and making a thorough medical examination of the patient, including specifically documenting spleen size, should undertake the following investigations under the guidance of a specialist.

Minimum established tests:

• real-time quantitative RT-PCR test to detect and measure the level of BCR-ABL1 on the international scale
• biochemistry screen including liver function tests, electrolytes, renal function tests, urate, lipase and amylase, blood sugar level
• HIV, hepatitis B and hepatitis C serology
• electrocardiogram.

Investigations that should be done in most circumstances:

• bone marrow aspiration including cytogenetics, immunophenotyping/flow cytometry and morphology (exceptions can be made for frail or very elderly patients)
• fasting lipids (not essential if the patient will receive frontline imatinib)
• chest x-ray (not essential for young, healthy patients).

The following tests are important in cases where a second-generation tyrosine kinase inhibitor (TKI) is being considered in a patient who may have a high risk of vascular disease (based on age or other factors):

• ankle brachial index
• Doppler study of neck and leg arteries
• cardiac echocardiogram.