Leukaemia (chronic lymphocytic)

Question 1

Definition

Answer 1

Characterised by progressive accumulation of functionally incompetent lymphocytes, which are monoclonal in origin. There is an overlap between CLL and non-Hodgkin’s lymphoma

Question 2

Aetiology/risk factors

Answer 2

· Malignant cells may accumulate as a result of their inability to undergo apoptosis

· The most common chromosomal changes include:
o Trisomy 12
o 11q and 13q deletions

Question 3

Epidemiology

Answer 3

· 90% are > 50 yrs
· More common in MALES
· Rare in Asians

Question 4

Presenting symptoms

Answer 4

· Asymptomatic - 40-50% of cases are diagnosed following routine blood tests

· Systemic Symptoms:
o Lethargy
o Malaise
o Night sweats

· Symptoms of Bone Marrow Failure:
o Recurrent infections
o Herpes zoster infection
o Easy bruising or bleeding

Question 5

Signs on physical examination

Answer 5

· Non-tender lymphadenopathy

· Hepatomegaly

· Splenomegaly

· LATE STAGE signs of bone marrow failure:
o Pallor
o Cardiac flow murmur
o Purpura/ecchymosis

Question 6

Investigations (blood)

Answer 6

· Bloods
o FBC
· Lymphocytosis
· Low Hb
§ Could be due to bone marrow infiltration, hypersplenism or autoimmune haemolysis
· Low platelets
· Low serum Ig

· Blood Film
o Small lymphocytes with thin rims of cytoplasm
o Smudge cells

Question 7

Investigations (other)

Answer 7

· Bone Marrow Aspirate or Biopsy
o Lymphocytic replacement of normal marrow

· Cytogenetics

· NOTE: CLL may be associated with autoimmune phenomena such as haemolytic anaemia (warm agglutinins) or thrombocytopaenia