Steroids (prednisolone, dexamethasone) are often prescribed along with chemotherapy. As well as treating the CLL, they help to reduce chemotherapy-related sickness and tiredness.

Steroids may also be given if your red blood cell count falls very quickly. This happens when your red blood cells are destroyed by proteins in the bloodstream and the spleen, and is called haemolysis.

If you develop haemolysis, you may become anaemic quite quickly. This is known as haemolytic anaemia. Symptoms include breathlessness, tiredness, a yellowish tinge to the whites of your eyes and dark-coloured urine. If you suddenly notice that you are very tired or breathless, contact the hospital at once. You may need to have a blood test, and possibly treatment.

Side effects

While you take steroids, you may notice that you have a bigger appetite than usual, feel more energetic and find it difficult to get to sleep. If you are taking steroids for a long time (over months, rather than weeks), you may develop other side effects including:

• swollen ankles (from fluid retention)
• raised blood pressure
• muscle weakness
• tiredness
• frequent infections
• a higher level of sugar in your blood
• sugar in your urine
• weight gain.

It is unusual for people with CLL to take steroids for so long that all these side effects occur. You should not suddenly stop taking steroids as this can make you feel ill and tired, so the dose is reduced over a period of time. If you need to stop treatment, your doctor will tell you how to manage this.

All these side effects are temporary and will gradually disappear when you stop taking steroids.