“My routine blood test showed raised lymphocytes and the word ‘leukaemia’ — I’m terrified, but I feel completely well”

A persistent, isolated mature LYMPHOCYTOSIS in an older adult is commonly CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL), confirmed by blood film and FLOW CYTOMETRY/immunophenotyping (iwCLL 2018, international: at least 5 × 10⁹/L clonal B lymphocytes; lower counts without node or organ involvement are monoclonal B-cell lymphocytosis), and is often INDOLENT and frequently diagnosed INCIDENTALLY in well, asymptomatic patients. Assess for clinical features and staging pointers — lymphadenopathy, hepatosplenomegaly, B symptoms (unexplained weight loss, drenching night sweats, fevers), anaemia/thrombocytopenia, and recurrent infections — and refer to HAEMATOLOGY for confirmation, staging (Binet/Rai) and a management plan. The reassuring reality to explain is "WATCH AND WAIT": many early-stage CLL patients need no treatment for years (sometimes never), are monitored with periodic bloods/review, and can have a near-normal life expectancy, with treatment reserved for progressive/symptomatic disease (rising counts/organomegaly, cytopenias, B symptoms). Counsel infection risk — CLL impairs immunity, so vaccinations (influenza, pneumococcal, COVID-19; check Shingrix eligibility; avoid live vaccines — Green Book), sun protection because skin cancers are more common, prompt treatment of infections, and reporting fevers/recurrent infections matter — and advise what to monitor/report (B symptoms, new lumps, infections, bleeding/bruising, fatigue). The communication core is the word "leukaemia": be honest that it is a cancer but provide calibrated reassurance (often very indolent, many never need treatment, near-normal life expectancy in many) without false promises or minimising, supporting both patient and family. Referral for a well patient with isolated lymphocytosis and normal haemoglobin and platelets is usually through the local haematology pathway, with faster review for cytopenias, bulky nodes, B symptoms or a rapid rise (BSH 2022); NICE NG12 very urgent FBC applies to adults with features of leukaemia, and a suspected cancer pathway referral is not the route once flow cytometry suggests CLL in a well patient. Inform the pre-operative team.