Increased vulnerability to infections is one of the main complications of chronic lymphocytic leukaemia.

If you have chronic lymphocytic leukaemia, your immune system will be weakened due to a reduced number of healthy, infection-fighting white blood cells. Chemotherapy and other powerful cancer-killing medication also weaken the immune system.

Having a weakened immune system makes you more vulnerable to infection – if you develop an infection, it's more likely to cause serious complications.

Due to the risk of infection, you should have a flu vaccination and a pneumococcal vaccination to protect against pneumococcal infections. Regular doses of antibiotics may also be recommended.

Report any possible symptoms of an infection to your GP or care team immediately. Prompt treatment may be needed to prevent serious complications developing.

Common symptoms of infection include:

• a high temperature (fever) of 38ºC (100.4ºF) or above
• headache
• aching muscles
• diarrhoea
• tiredness

Avoid contact with anyone who is known to have an infection, even if it's an infection to which you were previously immune, such as chickenpox or measles. Your previous immunity to these conditions may be lower because of the leukaemia.

You should also ensure that all of your other vaccinations are up-to-date. Your GP or care team can give you more advice about this.

However there are some types of vaccine, known as "live" vaccines, that you won't able to have, as they contains activated particles of the virus or bacteria they are designed to protect you against.

As your immune system will be weakened by the leukaemia and the treatment you receive, your risk of developing warts and verrucas will increase. They can also be more difficult to treat and, in rare cases, can develop into skin cancer.

Visit your GP immediately if you have a wart that changes colour or shape.

Richter syndrome

In a small number of people with chronic lymphocytic leukaemia (5% or less), the condition will change to become very similar to an aggressive form of non-Hodgkin lymphoma. This is called Richter's transformation or Richter's syndrome.

Symptoms of Richter's syndrome include:

• sudden swelling of your lymph nodes
• a high temperature not caused by infection
• night sweats
• weight loss
• abdominal pain

Richter syndrome is treated with a combination of chemotherapy and rituximab.

For more information about Richter's syndrome, see the Cancer Research UK website.

Autoimmune haemolytic anaemia

Around 10% of people with chronic lymphocytic leukaemia will develop autoimmune haemolytic anaemia, due to the breakdown of red blood cells. It's caused by the production of an antibody that targets and destroys the red blood cells.

Anaemia can be severe and it may cause you to become breathless or easily tired. Autoimmune haemolytic anaemia is usually treated with steroids, although other types of medication may also be used.

Psychological effects

Being diagnosed with chronic leukaemia can be very distressing, particularly if your condition can't be cured. At first, it may be very difficult to take in.

The situation can be made worse if you know your condition could become a serious problem later in life.

Having to wait many years to see how the leukaemia develops can be very stressful and may cause anxiety or depression.

If you've been diagnosed with leukaemia, talking to a counsellor or psychiatrist may help. Psychiatrists are doctors who specialise in treating mental health conditions.

Antidepressants or medication that reduces feelings of anxiety may also help you to cope better with the condition.

You may also find it useful to talk to other people who are living with leukaemia. Your GP or care team will be able to provide you with the details of support groups in your area.

Macmillan Cancer Support provides an excellent level of help and support. Their helpline number is 0808 808 00 00 (Monday to Friday, 9am to 8pm).

Infertility

Many treatments that are used for chronic leukaemia can cause infertility (an inability to conceive). Infertility is often temporary, but can sometimes be permanent. Your treatment team will be able estimate your risk of infertility.

It may be possible to take steps to guard against the risk of infertility before your treatment begins. For example, sperm samples can be stored so that they can be implanted in an embryo at a later date.

In some cases, it may also be possible to store a fertilised embryo. After treatment has finished, the embryo can then be placed back into the womb.