Chronic Lymphocytic Leukaemia

Question 1

Define:

Answer 1

Progressive accumulation of functionally incompetent partially mature B cells (monoclonal in nature) which have escaped programmed cell death

Question 2

Aetiology:

Answer 2

Malignancy cell accumulate due to their INABILITY TO UNDERGO APOPTOSIS.

Due to Chromosomal changes such as:

• Trisomy 12
• 11q and 13q deletions

Question 3

Risk factors:

Answer 3

Agent orange (herbicide chemical)

Question 4

Epidemiology:

Answer 4

Most common leukaemia in adults 4/100,000 per year

90% are over 50

More common in males but rare in asian

Question 5

Symptoms:

Answer 5

40-50% are asymptomatic 
Malaise 
Lethargy 
Night sweats 
Recurrent infections 
Herpes Zoster infection 
Easy bruising or bleeding 

IF severe: Weight loss, anorexia and sweats

Question 6

Signs:

Answer 6

Non-tender lymphadenopathy (rubbery and enlarged)

Hepatosplenomegaly

Late signs:
pallor
cardiac flow murmur
Purpura/ecchymosis

Question 7

Investigations:

Answer 7

FBC - lymphocytosis, low hb + platelets + ig + neutrophils due to marrow infiltration or hypersplenism. Later there is autoimmune haemolysis.

Blood film - small lymphocytes with rims of cytoplasm and smudge cells

Cytogenetics

Bone marrow aspirate or biopsy - lymphocytic replacement of normal bone