Chronic lymphocytic leukaemia

Published on 05/05/2015 by admin

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Last modified 05/05/2015

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126 Chronic lymphocytic leukaemia

Instruction

Perform a general examination of this patient.

Salient features

History

• Asymptomatic in 70% of patients

• Palpable lymph nodes or left upper quadrant abdominal discomfort in a fifth of patients

• Bleeding or bruising is rare

• Symptoms of anaemia are uncommon

• Weight loss, fever and night sweats are unusual.

Examination

• Usually men over the age of 40 years (male : female ratio is 2 : 1)

• Symmetrical, painless, rubbery lymph nodes

• Liver or spleen may be palpable.

Proceed as follows:

• Tell the examiner that you would like to do a FBC and examine the peripheral smear (lymphocytosis >15 × 10⁹ cells/l, with mature appearance of small lymphocytes) (Fig. 126.1).

Fig. 126.1 Peripheral blood smear demonstrating lymphocytosis: small lymphocytes with condensed chromatin, imparting a ‘soccer ball’ pattern, and scant cytoplasm (Wright stain).

(With permission from His ED. The leukemias of mature lymphocytes. Hematol/Oncol Clin North Am 2009;23:843–71.)

Remember that chronic lymphocytic leukaemia manifests clinically with organ infiltration with lymphocytes, immunosuppression (hypogammaglobulinaemia) and bone marrow failure.

Diagnosis

This elderly male patient with painless enlargement of lymph nodes probably has chronic lymphocytic leukaemia (lesion). He has severe pallor, indicating he is in Binet stage C (functional status).

Questions

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