3.1 Specialist diagnostic work-up

3.1 Specialist diagnostic work-up

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.

Specialist assessments should generally be completed within two weeks from the first haematologist appointment. However, the ankle brachial index, Doppler study and cardio echocardiogram tests that are recommended in selected cases are less time-critical and should be completed within six weeks.