Please enable JavaScript.
Coggle requires JavaScript to display documents.
Chronic lymphocytic leukaemia (CLL) (Clinical presentation (Asymptomatic…
Chronic lymphocytic
leukaemia (CLL)
Epidemiology
Commonest type of leukaemia
M>F
Elderly
Pathophysiology
Defect
Malingant change in a mature B-cell, which
replicates slowly and has some mature functions
Mechanism
Mature B cells proliferate slowly, causing
indolent disease
Often accumulate in LNs
Natural history
Often indolent for a long time
Can transform to acute (Richter's syndrome)
Risk
factors
Age
Clinical
presentation
Asymptomatic
Malaise, fatigue
Infections
Weight loss
Night sweats
Enlarged LNs
Diagnosis
Examination
Abdo exam
Hepatomegaly, splenomegaly, LNs
Investigations
Bloods
FBC (low Hb, low Plt, high WCC), U+E, LFT (deranged),
clotting (may be deranged), blood cultures (?sepsis)
Blood film (mature WBCs with smear cells, haemolysis)
Imaging
CXR: hilar LNs
CT abdo: abdo LNs, staging
Bedside
Obs (may have fever)
Weight/height (weight loss)
Biopsy
Immunohistochemistry, phenotyping, cytogeneitcs
History
DH
Meds, allergies
FH
Cancers
PMH
Previous cancers
SH
Living arrangements, occupation,
smoking, alcohol
PC/HPC
Asymptomatic, fatigue, weight loss,
night sweats, fevers, LNs
Classification
Binet
Stage A-C deoending on
organ enlargement, Hb, Plt
Rai
Stage 0-1 depending on lymphoctosis,
lymphadenopathy, anaemia, thrombocytopenia
Management
Medical
Chemotherapy
Indication: symptomatic/progressive disease
E.g. chlorambucil, CHOP, rituximab
Radiotherapy
Indication: LNs, splenomegaly
MOA: external beam RT
Surgery
Splenectomy
Conservative
Information, advice, support
MDT (medic and surgical specialist, specialist nurse,
psychology, counselling)
Compliations
Autoimmune haemolytic anaemia
Steroids
Pancytopenia
Tumour lysis syndrome
Allopurinol
Neutropenic sepsis
Infections
Definition
Malignant neoplasm of
leukocytes of lymphoid type
Prognosis
1/3 never progress,
1/3 slowly, 1/3 actively