I was just following a few posts this morning and it got me thinking back to my diagnosis a year ago and how it all played out. I was wondering if others had an experience like this and if it really is possible for experienced oncologists to make a confident call on CML and the phase before actually getting BMB/A results.
For my case, the initial event was a visit to my regular doctor after complaining about slower running and a weird "rushing" noise in my right ear. Doctor said my running was slower because I was getting a little bit older (early 40's, really?), and the sound in my ear was due to fluid in my ear drum. Regardless, he took blood just in case. Doctor got bloodwork results back on a Saturday morning, freaked out, called my wife, had me report immediately to the ER to be re-tested (after running a 5K road race, oddly enough), then an oncologist at the ER visually analyzed the fresh blood sample under a microscope with the aid of an acute leukemia specialist and verbally told me within 90 minutes that they were 99% confident that it was CML chronic phase with no mention at all of the possibility of accelerated or blast crisis phase. The whole ER deal is a bit of a surreal and blurred memory, but I recall asking how they were able to figure this out. She said that they were able to make the determination by carefully examining the shape of the WBC in the sample (figuring out that they were CML cells), and they thought they saw "maybe" 1 or 2 blast cells in the sample because sometimes a couple can "leak out of the marrow". So because the large amount of WBCs actually "looked" essentially normal in the blood sample, they were highly confident that it was chronic phase. And I assume that they couldn't see Ph+ under the microscope, so somehow they figured it out from the shape of the cells themselves. In addition, she said that my symptoms were quite vauge at the time and my spleen felt normal size, despite having 155,000 WBC. I've always been grateful that these doctors were supposedly knowledgable and experienced enough to look for certain things in a blood sample with their own eyes and make correct assumptions about how the bone marrow biopsy results would turn out; so much so that the onc in the ER wrote me a prescription for Hydro / Allopurinol and told me to leave and resume my weekend as planned and just get the biopsy scheduled for sometime the upcoming week, because insurance would need it to approve the prescription for Gleevec. But is this really possible to examine a diagnosis blood sample with experienced eyes to figure this stuff out with a fairly high degree of confidence?
Anyway, now that I know a decent amount about CML and how it's actually diagnosed, I've always questioned the ability of an oncologist of any experience level to diagnosis CML and phase through blood exclusively. But these two folks nailed it right out the gate.
Anyway, just wondering...