Signs and Symptoms of Chronic Lymphocytic Leukemia

Many people with chronic lymphocytic leukemia (CLL) do not have any symptoms when it is diagnosed. The leukemia is often found when their doctor orders blood tests for some unrelated health problem or during a routine check-up and they are found to have a high number of lymphocytes.

Even when people with CLL have symptoms, they're often vague and can be symptoms of other things. Overall, the signs and symptoms of leukemia can affect men or women and do not differ by sex or gender. Symptoms can include the following:

• Weakness
• Feeling tired
• Weight loss
• Chills
• Fever
• Night sweats
• Swollen lymph nodes (often felt as lumps under the skin)
• Pain or a sense of "fullness" in the belly (this can make someone feel full after only a small meal), which is caused by an enlarged spleen and/or liver

Many of the signs and symptoms of advanced CLL occur because the leukemia cells replace the bone marrow's normal blood-making cells. As a result, people don't have enough red blood cells, properly functioning white blood cells, and blood platelets.

• Anemia is a shortage of red blood cells. It can cause tiredness, weakness, and shortness of breath.
• A shortage of normal white blood cells (leukopenia) increases the risk of infections. You might hear the term neutropenia, which refers to low levels of neutrophils (a type of granulocyte needed to fight bacterial infections). People with CLL may have very high white blood cell counts because of excess numbers of lymphocytes (lymphocytosis), but the leukemia cells don't fight infection the way normal white blood cells do.
• A shortage of blood platelets (thrombocytopenia) can lead to excess bruising, bleeding, frequent or severe nosebleeds, and bleeding gums.

People with CLL have a higher risk of infections. This is mainly because their immune systems aren't working as well as they should. CLL is a cancer of B lymphocytes, which normally make antibodies that help fight infection. Because of the CLL, these antibody-making cells don't work as they should, so they can't fight infections. Infections may range from simple things like frequent colds or cold sores to pneumonia and other serious infections.

CLL can also affect the immune system in other ways. In some people with CLL, the immune system cells make abnormal antibodies that attack normal blood cells. This is known as autoimmunity. It can lead to low blood counts. If the antibodies attack red blood cells, it's called autoimmune hemolytic anemia. Less often, the antibodies attack platelets and the cells that make them, leading to low platelet counts. Rarely, the antibodies attack white blood cells, leading to leukopenia (low white blood cell counts).

These symptoms and signs may be caused by CLL, but they can also be caused by other conditions. Still, if you have any of these problems, it's important to see a doctor right away so the cause can be found and treated, if needed.