Chronic lymphocytic leukaemia

• Chronic lymphocytic leukaemia (CLL) is the most common form of leukaemia in adults in Western countries
• CLL is considered a lymphoproliferate disorder of B lymphocytes, which results from an abnormal clonal expansion of B cells that resemble mature lymphocytes
• Patients may be asymptomatic with indolent disease that remains stable for many years. Alternatively, patients may have progressive disease leading to death within 2-3 years of diagnosis.
• The symptomatic stage of CLL is characterised by progressive lymphadenopathy, which includes splenomegaly and hepatomegaly, that occurs due to the accumulation of incompetent lymphocytes.
• The hallmark feature of CLL is lymphadenopathy due to the infiltration of malignant B lymphocytes.
• B symptoms such as weight loss, fevers and night sweats are only seen in 5-10% of patients. B symptoms are much more associated with lymphoma.
• • Lymphadenopathy: seen in 50-90% of patients. Most commonly cervical, supraclavicular and axillary nodes.
  • Hepatomegaly and splenomegaly may be present
• The diagnosis of CLL is based on the presence of persistent lymphocytosis on a FBC that are found to be clonal - this can be assessed by flow cytometry
• Investigations:

  • FBC - lymphocytosis (may be extremely high) and normocytic anaemia
  • Blood film - characteristically shows smear or smudge cells
  • Haemolysis screen - direct antiglobulin test, haptoglobin, LDG, unconjugated bilirubin and reticulocytes
• CLL is associated with haemolytic anaemia and smudge cells
• Usually affects adults over 60

  Often asymptomatic but can present with infections, anaemia, bleeding and weight loss

  May cause autoimmune haemolytic anaemia