2.1 Signs and symptoms

2.1 Signs and symptoms

The following signs and symptoms should be investigated.

Most patients are asymptomatic when they are diagnosed. Often CLL is recognised after lymphocytosis is found during a routine blood test performed for other reasons. Symptoms can include (Hallek et al. 2018):

  • painless swelling of lymph nodes that may fluctuate in size but don’t completely resolve (within six to 12 weeks) – this can affect any lymph nodes but often occurs around the neck
  • unexplained weight loss of more than 10 per cent of body weight within the past six months
  • fever without signs of infection (rarely)
  • severe night sweats without signs of infection (uncommon)
  • extreme fatigue (prevents person from working or doing their usual activities)
  • frequent infections or first onset of herpes zoster reactivation. Other signs include (Binet et 1981; Rai et al. 1975):
  • lymphadenopathy – 50 to 90 per cent of patients experience enlarged lymph nodes (cervical, supraclavicular and axillary are the most common areas)
  • splenomegaly – 25 to 55 per cent of cases
  • hepatomegaly – 15 to 25 per cent of

Suggestive laboratory abnormalities

If any of the following abnormalities are found, CLL should be investigated as a possible underlying cause:

  • hypogammaglobulinemia – present in a quarter of patients at initial diagnosis and becomes more common as the disease progresses (Parikh et 2015)
  • autoimmune haemolytic anaemia
  • immune

The presence of multiple signs and symptoms, particularly in combination with other underlying risk factors, indicates an increased risk of CLL.

The timeframe to begin investigations is rarely urgent, except in cases where the patient presents with severe symptoms of fever, night sweats or weight loss. In these cases, investigations should be started as soon as possible to exclude more aggressive disorders such as lymphoma.