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.