A complete blood count with differential can narrow down the list of possible causes of anemia. There is the Red Blood Count, Hemoglobin count, Reticulocyte (immature red cell) count, Hematocrit plus the indices Mean Corpuscular Volume, Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Concentration. The red blood and hemoglobin analyses alone can rule out many possible causes. The White cell counts can also suggest the presence or absence of conditions associated with anemia, including blood cancers. Iron supplements can do more harm than good and should be avoided unless iron deficiency is confirmed by additional tests.

The effects of anemia are magnified in the presence of lung and cardiovascular diseases and other conditions that can cause fatigue, including lymphoma. Chronic Lymphocytic Leukemia is staged according to hemoglobin and platelet counts, which are indices of bone marrow suppression. However, even in early stages of CLL there can be advanced signs and symptoms of lymphoma, such as night sweats, frequent infections, moderate to severe fatigue and very low immunoglobulin levels together with normal or near-normal hemoglobin levels. Small-cell Lymphocytic Leukemia involves exactly the same type of cell as CLL, but likely originates in a lymph node and spreads to other lymph nodes before it gets established in the bone marrow. SLL looks like, is staged like and treated like some other indolent lymphomas. SLL is staged according to the Ann Arbor system and generally not treated in advanced stages unless there are b-grade symptoms (e.g., night sweats, frequent infections) or bulky lymph nodes, and the goal of treatment is to relieve symptoms and / or reduce lymph node size. CLL often develops characteristics of SLL in late stages, and sometimes in early stages. CLL diagnosed as old rai stage 1 or 2 might actually represent a late stage of SLL that has infiltrated the bone marrow. If there are 4,999 monoclonal lymphocytes in the blood stream at time of diagnosis, it is SLL, and if 5,000 it's CLL. However, characteristics of SLL can be very prominent in early stages of CLL. CLL specialists usually make treatment decisions in accord with International Workshop Guidelines for Diagnosis and Treatment of Chronic Lymphocytic Leukemia, which allows treatment of early stage CLL with b-grade symptoms or bulky and symptomatic lymph nodes, spleen and other organs. The criteria for and goals of treatment of CLL and SLL can be the same. I know from bitter personal experience that there are hematologists who are either not familiar with or do not agree with International Workshop guidelines, and ignore indications for treatment of an indolent lymphoma because they believe that they are dealing with a form of "leukemia" and not a lymphoma, at least not in early stages.

Disclaimer. I am a Licensed Practical Nurse who completed more advanced coursework in biology that is required for an RN license and have intensively studied subject related to diagnosis and treatment of CLL during the past 3 years, including basic hematology and immunology. I can recommend Mayo Clinic to anyone with CLL because there are CL-specialists within the department of hematology who follow International Workshop guidelines and are focused on treating CLL patients. Mayo Clinic has National Cancer Institute accreditation, which requires a much higher degree of specialization in treatment of cancers than is found in most oncology and hematology practices.

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