The correct answer is skin bruising. Platelets are mainly responsible for blood coagulation and protection from bleeding in case of injury. As a general rule, the presence of bruises on your skin without previous injury can be indicative of a decrease in platelet count. An additional sign can be the presence of small reddish spots known as petechiae. However, feeling tired is mainly associated with a decreased hemoglobin value rather than decreased platelet counts. Additionally, susceptibility to infections is mainly associated with decreased white blood cell counts rather than decreased platelet counts.

The correct answer is Fatigue. Hemoglobin is mainly responsible for gas transfer and is usually found in red blood cells. A decrease in hemoglobin value below certain a cut-off is known as anemia. Feeling tired is one of the main symptoms and signs of anemia and mainly due to inadequate oxygen transfer in our body. A decreased hemoglobin value is not associated with fever unless it is accompanied by other symptoms or signs suggestive of active disease. A decrease in hemoglobin value does not cause bruises on your skin unless it is associated with a decrease in platelet count.

The correct answer is Susceptibility to infections. Neutrophils are mainly responsible for fighting infections. As a result, a decrease in neutrophil count increases susceptibility to infections. Feeling tired is mainly associated with a decreased hemoglobin value rather than decreased neutrophil counts. A decrease in neutrophil count does not cause bruises on your skin unless it is associated with a decrease in platelet count.

Swollen lymph nodes is a common finding in many infections. However, infections are not the only pathological conditions associated with lymphadenopathy (swollen lymph nodes). Lymph nodes can swell as a result of many pathological conditions including both cancer and infections. Swollen lymph nodes is a common finding in many cancers, especially hematological cancers.

Chronic Lymphocytic Leukemia is a type of hematological cancer. The term lymphoma encompasses a wide range of hematological cancers.

Chronic Lymphocytic Leukemia (CLL) is a disease of mostly the elderly with a median age at diagnosis of 72 years.

CLL is a type of hematological cancer that initially affects the lymphocytes but as the disease evolves it may also affect hemoglobin and platelet counts.

The diagnostic test needed for establishing the diagnosis of CLL is flow cytometry. The CBC test indeed can show an elevated lymphocyte counts (lymphocytosis) however this finding is not diagnostic for CLL since there are many other conditions that can cause lymphocytosis. Bone marrow examination is not diagnostic for CLL.

Studies have shown that two or more members of the same family can suffer from CLL, however, CLL is not a hereditary disease nor a contagious disease.

We are still not certain about what causes CLL. Studies have shown that two or more members of the same family can suffer from CLL, however, CLL is not a hereditary disease. Therefore, there is no need for any genetic or other preventive medical tests by the patient’s relatives (first degree or other).

CLL is characterized by extreme heterogeneity in terms of clinical course and evolution. Some patients may experience a very indolent disease whereas others may experience an aggressive disease that is not responsive to treatment. In rare cases of the latter category, CLL can transform into an aggressive lymphoma with an immediate need for treatment. CLL and acute leukemia are not phases of the same disease. Even though the word “leukemia” is common to both terms, these are completely different diseases.

Even though we know a lot about CLL biology and evolution, we are still not certain about what causes CLL.

A patient recently diagnosed with CLL who is currently not receiving treatment for this disease can carry on with his/her everyday habits and life-style without any adjustments.

CLL is characterized by extreme heterogeneity in terms of clinical course and evolution. Some patients may experience a very indolent disease whereas others may experience an aggressive disease that is not responsive to treatment. Therefore one cannot make a general assumption about patient survival in CLL. Each patient is unique and should be considered separately.

On its own, the diagnosis of CLL is not a contradiction for any medication. However, you should always inform your physician about all kinds of drugs you are taking even if they are not given for CLL.

When a patient with CLL is not under treatment for this disease he/she can be treated as any other patient, provided of course that the attending hematologist is updated.

Establishing a diagnosis of CLL does not necessarily imply immediate treatment initiation. The decision for starting treatment depends on certain criteria, such as lab test results and findings from the clinical examination. Hence, there is no way of predicting the time for treatment initiation and each patient must be considered.

Establishing a diagnosis of CLL does not necessarily imply immediate treatment initiation. The decision for starting treatment is based on internationally accepted criteria. Hence, there is no way of predicting the time for treatment initiation and each patient must be considered separately.

For CLL, the decision for treatment initiation is based is based on internationally accepted criteria, including a significant decrease in hemoglobin value or platelet counts. Hence, there is no way of predicting the time for treatment initiation and each patient must be considered separately. An increase of the lymphocyte count alone is not a criterion for treatment initiation. A serious infection is not a criterion for treatment initiation either.

Screening for deletion of chromosome 17p by FISH analysis should always be performed before starting treatment as the decision about the type of treatment is informed by the results of this analysis. However, in case the FISH analysis for deletion of chromosome 17p is negative, then screening for TP53 gene mutations by DNA analysis is also considered necessary before treatment initiation.

There are many different treatments for CLL. The choice of treatment is based upon internationally accepted criteria that take into account biological/genetic characteristics of the CLL cells as well as the patient’s general medical condition. For most available treatment modalities there is a defined protocol specifying the duration of treatment.

Aspirin is generally not recommended for patients with hematological abnormalities due to the coagulation problems it may induce. You can however take paracetamol and inform your physician about your fever. The presence of high fever accompanied with chills is indicative of a bacterial infection and this situation can be very dangerous for a patient with low white blood cell count or an impaired immune system. Please inform your attending physician (or any other physician) about your fever.

While receiving treatment you may experience some adverse events. These may vary depending on the type of treatment and can include diarrhea, nausea, vomiting, decreased hemoglobin values, decreased platelet and/or white blood cell counts etc. Therefore while on treatment you may need to avoid crowded places, be careful about what you eat and avoid strenuous exercise.

While receiving treatment you may experience some adverse events such as lung infection that need immediate management. Shortness of breath and cough can be signs of a lung infection, therefore you should not wait but instead inform your physician immediately

The presence of red spots and bruises on your skin might be indicative of reduced platelet counts. Decreased platelet count is a sign of active disease and a criterion for treatment initiation. You should have a CBC test and inform your physician.

Adherence to medication is essential for the success of treatment. However if you accidentally miss a dose you should avoid taking extra capsules on the next dose to compensate for the missing one but rather continue with the treatment regimen and make a note to inform your hematologist at the next appointment.

While receiving treatment you may experience some adverse events that need medical management. Diarrhea can be one of those adverse events, therefore you should keep yourself hydrated and inform your physician immediately.