General practitioner examinations and investigations should include:

• history and physical exam including careful palpation of all lymph node areas, spleen and liver
• full blood count and manual film examination
• flow cytometry to confirm clonal nature of lymphocytes
• urea, electrolytes, uric acid and creatinine
• liver function tests
• serum immunoglobulin levels and direct antiglobulin test (Coombs’ test). Tests that are not usually required:
• lymph node biopsy is generally not necessary to diagnose CLL, even if lymphadenopathy is present clinically or on imaging
• routine imaging is not recommended – imaging should only be performed when there are concerns around local symptoms, compression or very bulky nodes to exclude a local complication such as hydronephrosis or vascular compression.