White blood cells are not necessarily elevated in leukemia.
White blood cell counts in leukemia can be as high as 300 × 10/L or as low as (0.2 to 0.3) × 10/L (hypoproliferative leukemia).
The white blood cell count is usually low in the early stages of acute leukemia and mostly high in the late stages. When the total white blood cell count is particularly high or low, the disease is often severe and the treatment is difficult and less effective. The presence of acute leukemia cells in the peripheral blood is an important basis for the diagnosis of acute leukemia. Acute leukemia is mainly characterized by primitive and promyelocytic (naive) cells. The diagnosis is not difficult when the total leukocyte count is high, but when the leukocytes are low, leukemic cells are often found only after a concentrated smear or up to the end of a blood smear. The blood picture of promyelocytic leukemia or hypoproliferative leukemia is often totocytopenic.
Chronic granulocytic leukemia: The leukocyte count is markedly increased in the chronic phase, higher than 20×109/L in the early stages and up to 100×10/L in the late stages. Neutrophils are seen in all stages, with predominantly neutrophils, late neutrophils, and rod nucleated granulocytes; eosinophils and basophils are increased; anemia may be present; platelets are normal or increased in the early stages and gradually decrease in the late stages.
Chronic lymphocytic leukemia blood count: peripheral blood B lymphocytes ≥5×10/L and persistent for at least 3 months.
The diagnosis of leukemia is confirmed by bone marrow aspiration. By the morphology of the bone marrow, primitive cells above 20% are acute leukemia. The diagnosis of leukemia is very complex, and precise diagnostic staging is currently common internationally with cytomorphology, immunology, cytogenetics, and molecular biology staging, which we often refer to as MICM staging. 1. M is FAB staging; 2. I Typing based on immunological markers on the surface of leukemic cells; 3. C Leukemia often associated with chromosomal alterations; 4. M Chromosomal alterations with gene-specific changes.