NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
19 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 2 Treatment planning Blood tests Abnormal levels can be caused by cancer or other health problems. Hepatitis B testing CLL and some of its treatments can cause the hepatitis B virus to become active again. Thus, tell your treatment team if you’ve ever been infected with hepatitis B. For others, ask your treatment team if you should get tested. Quantitative immunoglobulins There are three major types of antibodies in blood. They are IgG, IgA, and IgM. Your blood can be tested to measure the amount of each type of antibody. Testing will show if the level of any type of antibody is abnormal—too high or too low. See Figure 6. Some people with CLL have low levels of antibodies before cancer treatment. They may be sick often. Testing of antibodies can help your doctors know if you need treatment to prevent or cure an infection. Haptoglobin Haptoglobin is a protein made by the liver. It attaches to free hemoglobin in blood to mark it for removal. Free hemoglobin is a protein with iron that was released from destroyed red blood cells. Low amounts of haptoglobin can be a result of autoimmune hemolytic anemia. Autoimmune hemolytic anemia is when your body mistakes red blood cells for invaders and destroys them. Haptoglobin level is one of the tests needed to confirm autoimmune hemolytic anemia. Autoimmune hemolytic anemia is common among people with CLL. Advanced CLL and some of its treatments can cause it. A cancer treatment called fludarabine should not be used if you have severe autoimmune hemolytic anemia. Reticulocyte count and direct Coombs test Low numbers of healthy red blood cells is called anemia. There are many causes of anemia. Two of the many causes are pure red cell aplasia and hemolysis. Pure red cell aplasia is when the early (precursor) cells that form into red blood cells are almost absent in bone marrow. Hemolysis is when red blood cells are being destroyed too early. If you have anemia, you should be tested for these causes. Reticulocytes are precursor cells of mature red blood cells. Low numbers of reticulocytes is a sign of pure red cell aplasia, and high numbers indicate hemolysis. The other test is a direct Coombs test. This test can detect if antibodies are stuck to and killing red blood cells. Beta-2 microglobulin Beta-2 microglobulin is a small protein made by many types of cells, including CLL cells. It is measured with a blood chemistry test. High levels of this protein may be a sign of CLL that is harder to treat. LDH LDH is a protein that is in most cells. It gets into your blood when a cell is damaged. Thus, a high level of lactate dehydrogenase is a sign of cell damage. High levels can be caused by cancer or other health problems. If related to cancer, high levels may be a sign that treatment may be needed now or soon. Uric acid Some people with CLL are at risk for tumor lysis syndrome. This syndrome can be life threatening. It occurs when the waste released by dead cells is not quickly cleared out of your body. This results in kidney damage and severe blood electrolyte disturbances.