NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

15 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 2  Treatment planning Physical exam | Blood tests Physical exam A physical exam is a study of your body. It is done to look for signs of disease. It is also used to help assess what treatments may be options. To start, your basic body functions will be measured. These functions include your temperature, blood pressure, and pulse and breathing rate. Your weight will also be checked. Your doctor will listen to your lungs, heart, and gut. He or she will also assess your eyes, skin, nose, ears, and mouth. Parts of your body will be felt. Your doctor will note the size of organs, such as your liver and spleen. He or she will see if organs feel soft or hard. Tell your doctor if you feel pain when touched. Your doctor will also rate your performance status. Performance status is your ability to do daily activities. It is used by doctors to assess if you can have certain treatments. Blood tests Doctors test blood to look for signs of disease. Blood tests require a sample of your blood. Blood samples can be removed with a blood draw. Blood draw Some blood draws require no eating and drinking for hours. Your doctor will say if you can eat or drink. Blood samples will be removed from a vein with a needle. CBC with differential A CBC ( c omplete b lood c ount) measures parts of the blood. Test results include counts of white blood cells, red blood cells, and platelets. Cancer and other health problems can cause low or high counts. There are several types of white blood cells. A differential counts the number of each type of cell. It also checks if the counts are in balance with each other. Comprehensive metabolic panel Chemicals in your blood come from your liver, bone, and other organs. A comprehensive metabolic panel often includes tests for up to 14 chemicals. Low or high levels can be caused by cancer or other health problems. Beta-2 microglobulin Beta-2 microglobulin is a small protein found on most cells. It is released by cells into the blood, especially by B cells. High levels may be a sign of CLL that is harder to treat. Haptoglobin, reticulocytes, DAT Hemoglobin is a protein in red blood cells. It carries oxygen from your lungs to the rest of your body. When red blood cells die, hemoglobin is released into the blood. Low amounts of hemoglobin is called anemia. There are many types of anemia based on what is causing it. Autoimmune hemolytic anemia Autoimmune hemolytic anemia is when your body destroys red blood cells. It can be caused by advanced CLL and some of its treatments. Fludarabine should not be used if you have severe autoimmune hemolytic anemia. Three tests are needed to confirm autoimmune hemolytic anemia. One test is the haptoglobin level. Haptoglobin attaches to hemoglobin in blood to mark it for removal. Another is the reticulocyte count. Reticulocytes are young red blood cells. The third test is DAT ( d irect a ntiglobulin t est; also called direct Coombs’ test). This test can detect if antibodies are stuck to and killing red blood cells.