Chronic Lymphocytic Leukaemia
·
Monoclonal proliferation of
mature B cells (CD 19 & 20+). Being mature, will have surface expression of
immunoglobulins
·
Commonest leukaemia: 25%.
·
Primarily elderly
·
Male = 2 * Female
·
Asymptomatic (40 – 70%)
·
Insidious, maybe weight loss,
fatigue
·
Symmetrical enlargement of
superficial lymph nodes (50%)
· Splenomegaly and hepatomegaly
· ¯Platelets ® bruising
·
Defects in CMI and ¯Ig ®
infections: Herpes Zoster (shingles), fungal, bacterial, viral. Death usually
due to infection
·
Blood lymphocytes > 5 * 10E9/L
·
Lymphocytes are B cells (CD19, 20
and 24)
·
Marrow lymphocytosis > 30%
·
Reactive lymphocytosis: EBV, CMV,
HZV, Toxoplasmosis, Brucellosis, Tb, Viral
·
Other B cell tumours:
o Prolymphocytic anaemia
o Hairy cell leukaemia
o Splenic lymphoma with villous lymphocytes
o Mantle cell lymphoma
o Follicular lymphoma
· 20% diagnosed on routine blood test
·
Lymphocytosis: > 5 * 10E9/L,
but may be 30 to 300. Small lymphocytes and smudge cells common. (cytoplasm
fragile – breaks easily)
· Normal looking lymphocyte: small, little/no cytoplasm
· Anaemia in later stages due to marrow replacement and ¯survival. 15% have Combes positive haemolytic anaemia
·
Marrow: lymphocytic replacement
·
10% have haemolytic anaemia
·
Only if nodes painful: Prednisone
(1 mg/kg), Chlorambucil, fludarabine. Side effects of prednisone: weight gain,
hyperexia, mood changes (euphoria ® depression), candidiasis,
polyuria (secondary to glucose intolerance), dyspepsia
·
Supportive treatment for
infections, and radiotherapy for deposits causing pressure symptoms
·
Little impact on viscosity (its
mainly RBCs and blasts that affect that)
·
Doesn‟t convert to Acute
Lymphatic Leukaemia
·
Median survival from diagnosis: 4
years. But 15% live for 15 years with no
treatment
·
Infections, secondary to
hypogammaglobulinaemia, neutropenia, drugs (immunosuppressive)
·
Cardia dysfunction: secondary to
chemo toxicity, etc
·
DVT: hypercoagulable
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