Diagnosis

FBC lymphocytosis >5.0 x 109/L; usually >20 x 109/L, occasionally >400 x 109/L; anaemia, thrombocytopenia and neutropenia absent in early stage CLL; autoimmune haemolysis ± thrombocytopenia may occur at any stage.

Blood film: lymphocytosis with 'mature' appearance; characteristic artefactual damage to cells in film preparation produces numerous 'smear cells' (Note: absence of smear cells should prompt review of diagnosis); spherocytes, polychromasia and 4 retics if AIHA; 5 platelets if BM failure or ITP.

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