The clinical examination should include:
- Lymph node palpation
- Liver and spleen palpation
- Height and weight
ABO typing, hemoglobin, leukocytes with differential counting, thrombocytes, blood smear, LD, albumin, creatinine, Na, K, Ca, phosphate, urate, glucose, CRP.
- Protein electrophoresis of serum/plasma and quantification of Ig
- Direct antiglobulin test (DAT). DAT should be repeated in all patients with anemia and before starting treatment.
- Reticulocytes – determination of reticulocytes should be done in all patients with anemia before starting treatment.
- Biochemical kidney and liver parameters. Determination of these parameters including urate should be done at the time of diagnosis and treatment start (at minimum).
Flow cytometry of blood or bone marrow
Immunophenotyping of lymphocytes in blood (or bone marrow) should be performed in all patients and at least in all who need treatment/before start of treatment. Additionally, immunophenotyping may be performed in patients with mild lymphocytosis to confirm the diagnosis and in patients with atypical morphology to exclude leukemized forms of other chronic lymphoproliferative diseases.
Bone marrow examination
Examinations of bone marrow are not required to diagnose the leukemia, but are considered necessary before starting treatment. This is partly because the examination contributes to clarifying the cause of cytopenia and partly because the bone marrow examination is necessary to evaluate the response to treatment. The examination may also contribute to diagnostic information in atypical lymphocyte morphology or low CLL score.