Chronic lymphoid leukaemia

Question 1

who are most affected?

Answer 1

elderly

Question 2

risk factors

Answer 2

age

7 times more likely if 1st degree relative with it

Question 3

what cells are affected?

Answer 3

B lymphocytes

Question 4

symptoms

Answer 4

weight loss
night sweats 
infections 
bleeding 
splenomegaly 
abdominal pain 
thrombocytopenic rash

Question 5

which other sites can be affected?

Answer 5

blood 
bone marrow 
liver 
spleen 
lymph nodes

Question 6

investigations

Answer 6

blood film 
bone marrow aspirate 
coombs test 
test for tumour protein 53 gene 
lymph node biopsy

Question 7

blood film findings

Answer 7

smudge and smear cells

Question 8

coombs test

Answer 8

direct antiglobulin test - positive indicates diagnosis

Question 9

test for TP53 gene

Answer 9

deletion indicates worse prognosis and they are less responsive to treatment

Question 10

diagnostic criteria

Answer 10

> 20% lymphoblasts in bone marrow
5000 B lymphocytes in peripheral blood for >3months with clonality
positive coombs test

Question 11

positive coombs test

Answer 11

indicates autoimmune haemolytic anaemia

Question 12

management

Answer 12

stem cell transplant - cure

depends on stage - chemotherapy or steroids

Question 13

how to manage relapse?

Answer 13

symptomatic treatment only

Question 14

prognosis

Answer 14

worsened by TP53 gene deletion
long survival initially
relapse = worse prognosis