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I've just been diagnosed with chronic lymphocytic leukaemia (CLL). My haemoglobin is 12.1, platelets 86 and white blood cell (WBC) count 91. The consultant has advised me to start chemotherapy shortly but I had planned to try scuba diving before all this. Is diving still a possibility? I am aware my comparatively low platelet count would be a problem if I were to cut myself or worse but are there any other implications. With thanks for any advice you can offer.

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Very sorry to hear of your diagnosis. The leukaemias are a group of disorders, basically cancers, of the blood or bone marrow. What distinguishes them is the rapid proliferation of abnormal white blood cells. In the acute form, many immature non-functional cells overcrowd the bone marrow, making it unable to produce healthy cells, and so treatment needs to be immediate. The chronic type takes much longer, but still results in the presence of many abnormal cells in the blood. It tends to affect an older age group, and sometimes is monitored for a time to determine when treatment will be most effective.

Despite the fact there are excessive numbers of cells in the blood, the symptoms result from the lack of normal, functioning ones. Platelets are crucial to blood clotting, so the low count can lead to easy bruising, prolonged bleeding from cuts or scrapes, or in the worst case, a spinal DCI. White cells are an important line of immune defense, making a leukaemia sufferer more prone to picking up infections, and to those infections being much worse than usual. Finally, the depletion of red blood cells, so important for carrying oxygen around the body, renders the patient anaemic and often breathless with poor exercise tolerance as a result.

Treatments for all leukaemias have improved vastly over recent years, but as a disease it still shortens lifespan. With CLL, however, some patients may require no treatment if their disease progression is sufficiently slow. As regular readers will know, Im never one to give a blanket no to anyone, as I believe in assessing on a case-by-case basis, and it is possible that you could dive, based on your current condition and symptoms. Once chemotherapy has started, however, your chances would be much slimmer, due to the side effects of the agents used.

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