Signs and Symptoms of Chronic Lymphocytic Leukemia (CLL)

Many people with chronic lymphocytic leukemia (CLL) do not have any symptoms when it is diagnosed.

CLL is often found when blood tests show a high number of lymphocytes (a type of white blood cell). This is usually discovered when a doctor orders blood tests during a routine checkup or for some other health problem. If CLL does cause symptoms, they can include things like fatigue, weight loss, fever, and swollen lymph nodes.

Possible symptoms of CLL

Even when people with CLL have symptoms, they’re often vague and can be caused by other things.

Symptoms can include:

• Feeling weak or tired
• Weight loss
• Chills
• Fever
• Night sweats
• Swollen lymph nodes (often felt as lumps under the skin in the neck, shoulder, underarm, or groin region)
• Pain or a sense of "fullness" in the belly caused by an enlarged spleen and/or liver. This can make you feel full after only a small meal.
• Reddish or purplish areas on the skin (most often on the face)

Signs and symptoms from low blood cell counts

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

A shortage of red blood cells (anemia) can lead to:

• Feeling very tired
• Weakness
• Shortness of breath

A shortage of normal white blood cells (leukopenia) increases the risk of infections.

You might also hear the term neutropenia. This 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
• Bleeding gums

Low blood cell counts from autoimmunity

CLL is a cancer of B lymphocytes, which normally make antibodies that help fight infections. In some people, the CLL 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 and cause them to break down, it’s called autoimmune hemolytic anemia (AIHA).
• Less often, the antibodies attack platelets and the cells that make them, leading to low platelet counts. This is called immune thrombocytopenia (ITP).
• Rarely, the antibodies attack white blood cells, leading to leukopenia (low white blood cell counts).

Tell your doctor about possible CLL symptoms

The symptoms and signs above 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 so the cause can be found and treated if needed.