B-cell chronic lymphocytic leukemia - Chronic
Rahul Soman, M. Pharm
Definition
Proliferation and progressive accumulation of morphologically mature but immunologically less mature monoclonal B-cells in the blood, bone marrow, and lymphoid tissues
Medical History
* White
* Male
* Middle-aged or Older
* Family history of Lymphoid leukemia
* Russian or Eastern European Jew
Findings
* Asymptomatic
* Lymphadenopathy
* Hepatosplenomegaly
* Asthenia
* Fatigue
* Fever
* Night sweats
* Weight loss
* Increased susceptibility to infections
* Blood coagulation disorder
* Insect bite reaction
* Easy bruising
Tests
Suspected chronic lymphocytic leukemia
* Complete blood count with white cell differential, manual: Lymphocyte count ranges from 5 to 500 x 109/L in CLL; neutrophil proportion, hemoglobin, and platelets are decreased .
Initial evaluation of suspected chronic lymphocytic leukemia
* Lymphocyte count by cell surface antigen phenotype
Initial evaluation of suspected chronic lymphocytic leukemia
* Lymphocyte surface immunoglobulin identification
Suspected and known chronic lymphocytic leukemia
* Bone marrow examination: Bone marrow lymphocyte count may range from 30% up to 99% of all nucleated cells; a diffuse pattern of lymphocytic infiltration has a poor prognosis .
Initial evaluation of suspected and known chronic lymphocytic leukemia
* Serum protein electrophoresis
* Immunoglobulin measurement
* Coombs test - anti-human globulin
Initial evaluation of chronic lymphocytic leukemia and treatment planning
* Hepatic function panel
* Biochemical evaluation of blood urea/renal function
* Electrolytes measurement, serum
Differential Diagnosis
* Hairy cell leukemia
* Waldenström macroglobulinemia
* Prolymphocytic leukemia
* Large granular lymphocytic leukemia
* Mantle cell lymphoma
* Smoldering chronic lymphocytic leukemia
Treatment
Procedural Therapy
Chronic lymphocytic leukemia
* Hemopoietic stem cell transplant: Stem cell transplantation increases disease-free survival and may increase overall survival in poor-risk CLL patients .
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