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Chronic lymphocytic leukaemia (CLL) symptoms and diagnosis

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Chronic lymphocytic leukaemia (CLL) tests for diagnosis

There's a range of tests you'll have to confirm whether CLL is the right diagnosis.

It’s important that you understand your diagnosis when you get it. It might be a good idea to ask your consultant to write it down so you can use it if you’re looking for more information or support, or if you need to tell other people about it.

At any time, you can ask your healthcare team to explain why you’re having a certain test and what the results mean.

Here's a list of the tests used to confirm whether you have CLL:

A full blood count (FBC) measures the number of each type of cell in the blood: red cells, white cells and platelets. You might be sent for this test by your GP as part of a routine check-up. Or you might have one when you’re in hospital for something else.

If your FBC shows that you might have CLL, you’ll need to go to hospital for more tests. If you’re diagnosed with CLL, you’ll have regular FBCs to monitor your condition.

On its own, an FBC doesn’t confirm a CLL diagnosis. You’ll need to have more specialist tests such as immunophenotyping to do this.

Immunophenotyping is a technique used to find out if you have abnormal CLL cells in your blood and if so, how many there are. It’s very sensitive, even if there’s only a small number of CLL cells there, it can still see them.

You might also have a peripheral blood film test, where your blood cells are looked at under a microscope. Because CLL cells look different to normal white blood cells, this test can help to identify any of these abnormal cells in your blood. 

If you have CLL, there will be more lymphocytes in the blood film than there should be.

Most people with CLL won’t need a lymph node biopsy to have a diagnosis, because the condition is usually diagnosed in the blood. You might need a lymph node biopsy to make a diagnosis if you’ve got swollen lymph nodes and your FBC is normal. This could mean you have what’s sometimes referred to as small lymphocytic leukaemia or SLL. Or much more rarely, it might be due to another condition called Richter’s syndrome (a different type of lymphoma).

A small number of CLL patients go on to develop this condition, where there’s usually a more rapid growth of lymph nodes in a single site.

Another reason you might have a lymph node biopsy is to rule out other lymphoid diseases such as mantle cell lymphoma (MCL).

A lymph node biopsy is a minor surgical procedure where a small sample is taken from a lymph node then studied under a microscope to check for signs of disease. You’ll need a small number of stitches but you can normally go home on the same day and have them removed around a week later. If the node is easy to reach, the biopsy can be done under local anaesthetic.

Sometimes the whole lymph node is removed; this is called an excision biopsy. This procedure may be helpful to improve the accuracy of a diagnosis.

We have more information on lymph node biopsies.

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Just diagnosed

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