B-ALL symptoms and tests
The main signs and symptoms you get with B-ALL are caused by a lack of normal, healthy blood cells. This is because there are too many leukaemia (blast) cells in your bone marrow.
If your GP thinks you may have leukaemia, they will refer you to hospital urgently for tests to confirm your diagnosis.
This page explains the common symptoms of B-ALL and the tests used to diagnose it.
Symptoms of B-ALL
Because B-ALL develops fast, symptoms usually appear quite quickly over a few weeks.
Some of the most common symptoms of B-ALL include:
- unexplained tiredness (fatigue)
- bruising and bleeding.
This can include:
- bruising easily
- bleeding from your gums or nose
- bleeding from wounds, which is hard to stop
- black, tarry poos or poos that are streaked with red, because of bleeding in your gut
- headaches, difficulty speaking or difficulty moving parts of the body, because of bleeding in the brain. - more infections than usual
- weight loss
- pain in the bones or joints
- lumps in the neck, armpit or groin
Some symptoms look different on different skin tones.
Many of the symptoms of B-ALL are common in other conditions. Because of this, it can sometimes take a week or two to diagnose.
If you are worried you might have leukaemia
Seek medical advice immediately because fast diagnosis is key. See our blood cancer symptoms guide for what symptoms to watch out for and questions to ask your doctor.
Tests to diagnose B-ALL
If your GP thinks you may have leukaemia, they will usually refer you urgently to a hospital for tests to confirm a diagnosis.
Doctors need the results of a number of different tests to diagnose B-ALL.
Below are some of the tests you may have during diagnosis and treatment.
Full blood count (FBC)
A full blood count (FBC) is a blood test which measures the number of each type of cell in your blood: red blood cells, white blood cells and platelets. Your GP may send you for this test because you’re feeling unwell, or you might have one as part of a routine check-up.
If your FBC shows that you may have leukaemia, you’ll need to go to hospital for more tests. If you’re diagnosed with ALL, you’ll have regular FBCs to monitor your condition during treatment and afterwards.
Bone marrow biopsy
A bone marrow biopsy is a test that lets doctors see what’s happening inside your bone marrow. It shows the types and numbers of blood cells and the levels of leukaemia cells. This test is usually needed to confirm a diagnosis of ALL because sometimes leukaemia cells are in the bone marrow but can't yet be found in the blood.
Find out more about having a bone marrow biopsy.
It’s normal to feel anxious about a bone marrow biopsy. You might find it helpful to chat to others who have also had this type of test. You can do this on our online community forum.
Immunophenotyping or flow cytometry
Immunophenotyping, also called flow cytometry, looks at the pattern of proteins on the surface of leukaemia cells. This can confirm a diagnosis of ALL and tell your doctor which type you have.
Cytogenetic tests
Cytogenetics is the study of genes. Genes are what makes up some of the sections of your DNA. People with B-ALL will have changes in the genes of their leukaemia cells. Information about these gene changes is very important. It will tell your hospital team more about your type of B-ALL.
Infection screening
When you are diagnosed with ALL, you’ll also have a general health check-up. This will help work out if you’ll be particularly vulnerable to side effects from treatment.
You will have a range of tests to check your heart, liver and kidneys. It’s also routine to be tested for HIV, hepatitis B and hepatitis C, so that if you have these conditions without knowing, they can be treated at the same time as the leukaemia.
Lumbar puncture
Leukaemia cells can sometimes spread into the fluid around the brain and spinal cord. This fluid is called cerebrospinal fluid (CSF).
A lumbar puncture is a test used to check whether leukaemia cells are present in the CSF. You will likely need these throughout all stages of your treatment.
Before the procedure, your doctor will numb the area with a local anaesthetic. A thin needle is carefully inserted into the lower part of your spine to collect a small sample of fluid. Once the sample has been taken, chemotherapy used to treat ALL may be injected directly into your CSF. This helps to kill any leukaemia cells that may be present and also reduces the risk of the leukaemia cells spreading to this area.
You might feel a bit of pressure or it might feel a bit uncomfortable while it’s being done, but it should not be painful.
A lumbar puncture usually takes about 15 to 20 minutes and is carried out in hospital.
Other tests and scans you might have
Some people might also have some of the below tests. Not everybody needs every test, so don’t worry if your hospital team does not suggest you have them.
Liver function, urea and electrolytes tests
You may have other blood tests to check how well your liver and kidneys are working. These tests help your hospital team decide what doses of drugs you need.
Tissue typing
If your doctor thinks you might need to have a stem cell transplant as part of your treatment, your hospital team will carry out tissue typing (also called HLA typing). This is a blood test which checks your white blood cells for proteins called HLA markers.
This is done by taking a sample of your blood. Your blood sample will then be tested to look for the human leukocyte antigen (HLA) proteins on the surface of your white blood cells. If you need a stem cell transplant using cells from another person (a donor) as part of your treatment, this information is used to find a donor whose stem cells are a close match to your own. If you have brothers or sisters, your doctor may ask them to be tested in case they’re a match and can be a potential donor for you. This is because there is a 1 in 4 chance (25%) that a person’s siblings will be a perfect match.
If your doctor thinks you might need to have a stem cell transplant as part of your treatment, your hospital team will carry out tissue typing (also called HLA typing).
X-ray
X-rays provide very good images of the denser tissues in the body, such as bone. You may have an X-ray when you are first diagnosed, to check for infection or any other chest problems.
Computerised tomography (CT or CAT) scan
A CT scan is a type of X-ray. You will lie on a table that moves into a doughnut-shaped machine while the pictures are taken. You may need to have a dye injected into one of your veins, to help get a better image.
This is not a routine test during the diagnosis and treatment of ALL but there may be specific reasons it needs to be done, such as if you have a swollen liver or spleen when you are diagnosed.
Magnetic resonance imaging (MRI) scan
Another type of scan is an MRI scan. This scan shows up soft tissues (non-bony parts) in your body and uses radio waves rather than X-rays. You’ll be asked to lie on a table, which will move you through the scanner. You may need to have an injection of some dye.
An MRI scan is not a routine test during diagnosis and treatment of ALL, but there may be specific reasons for having one.
Positron emission tomography (PET) scan
A PET scan involves an injection of a sugar (glucose) that is labelled with a very small amount of radiation. This helps show up what’s happening inside your body. The levels of radiation used are very small and won’t harm you. It’s rare to have this test, but it may be done if doctors suspect there are leukaemia cells in your lymph nodes (glands), liver or spleen.
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This information has been accredited with the PIF TICK, the UK's only quality mark for trusted health information.
Last full review June 2026. Next full review due June 2029. We may make factual updates between reviews.
Thank you to Consultant Haematologists Professor Adele Fielding and Dr Clare Rowntree for checking the clinical accuracy of our adult B-cell acute lymphoblastic leukaemia (B-ALL) information.
Thank you also to Karis, Ricky, Binu, Harry, Keri and Jesús for sharing their experiences and for helping with the creation of this information.