Chronic Lymphocytic Leukaemia Flashcards
What type of cells proliferate in CLL?
Well-differentiated lymphocytes, usually B-lymphocytes, involve blood and lymph nodes
Who is most commonly affected by CLL?
Adults over 65 years; it is the most common leukaemia in adults
What are the common symptoms of CLL?
Often asymptomatic; may present with infections, anaemia, bleeding, or weight loss
What are “B symptoms” in CLL?
Night sweats, fever, and weight loss
What autoimmune condition is associated with CLL?
Warm autoimmune haemolytic anaemia
(positive Direct Antibody/Coombs’ test)
What infection is commonly seen in CLL patients?
Community-acquired pneumonia.
What autoimmune abnormalities may occur if Hb is normal in CLL?
Autoimmune cytopenia
Autoimmune haemolysis
Autoimmune thrombocytopenia (ITP)
What are typical findings on blood count in CLL?
- Normal or low Hb
- Increased WCC (may be very high)
- Normal or low platelets.
What does a blood film show in CLL?
Lymphocytosis (>5×10⁹/L) and smudge cells
What is Richter transformation in CLL?
The transformation of low-grade (chronic) CLL to high-grade (acute) lymphoma, like DLBCL
What markers are detected in immunophenotyping for CLL?
Mainly CD19/20 and CD5 B cells with weak surface immunoglobulins
What cytogenetic abnormality is most common in CLL?
Deletion of 13q
What test is positive in warm autoimmune haemolysis associated with CLL?
Coombs’ test
What happens to immunoglobulin levels in CLL?
They may be low or normal
How is asymptomatic CLL managed?
No treatment is required
What are absolute indications for CLL treatment?
- Weight loss >10% over 6 months
- Night sweats >1 month
or - Progressive marrow failure (anaemia or thrombocytopenia)
What high-grade lymphoma can CLL transform into?
Diffuse large B-cell lymphoma (DLBCL) through Richter transformation
What are the complications of Chronic lymphocytic leukaemia?
(1) Richters transformation
(2) Bone marrow failure
(3) Warm AIHA
(4) Recurrent infection
How is the prognosis of chronic lymphoid leukaemia staged?
Prognosis is determined by Rai Stage worsening from 0-4.
- Lymphocytosis
- Lymphocytosis and Lymphadenopathy
- Lymphocytosis and Hepato/splenomegaly
- Lymphocytosis and Anaemia
- Lymphocytosis and Thrombocytopenia
Where does CLL typically present?
male patients over the age of 60, and is often picked up incidentally as a raised white cell count
fevers, weight loss, night sweats indicates what diagnosis?
Chronic Lymphocytic leukaemia as those are B cell symptoms
A 52-year-old male patient presents to the general practitioner with a 4-week history of weight loss and malaise. He also reports discomfort in the left upper abdomen and abdominal fullness. There is no past medical history noted. He denies any recent travel.
On physical examination, a mass arises from the left upper quadrant, extending to the right iliac fossa. The mass has a palpable notch and a dull percussion note
Why wouldn’t smudge cells be found?
CLL typically presents in male patients over the age of 60, and is often picked up incidentally as a raised white cell count
Would you expect to see a massive splenomegaly on a patient diagnosed with CLL?
Nope. Seen in patients who have CML
A 70-year-old man is referred to a haematology clinic after a routine blood test at his GP shows an incidental finding of a raised white cell count. Further blood results show abnormal proliferation of genetically identical cells, expressing CD20 and exclusively kappa light chains. Smudge cells are present on blood film.
The proliferation of what type of blood cell has likely caused this man’s condition?
B cell Lymphocyte
Chronic lymphocytic leukaemia is most associated with what?
Anaemia
