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Most of the workup for leukemia is based on blood samples, but often you need a bone marrow sample as well. Using the complete blood count, you can suspect leukemia if one sees what are called "blasts", which are the leukemia cells. Leukemia, however, originates from the bone marrow. Often, you won't see ANY blasts in the peripheral blood; rather, the peripheral blood counts will all be low because the bone marrow is not doing it's job properly. In this case, the leukemia cells are hiding in the bone marrow, which requires one to take a sample of bone marrow from the top of the pelvis.
I think with the complete blood count showing raised total white cell count over 50,000 with blood picture showing blast(large immature) white blood cells,one can begin to look at leukemia.Bone marrow sample examination can be done in a case where the above is not clear.
Very true! Unfortunately, once someone is in blast crisis (i.e. with WBCs in the 50s) the disease has already presented itself. Usually leukemia doesn't present in blast crisis; rather, pancytopenia or LOW blood counts because the bone marrow is not doing its job.

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