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Chronic Lymphocytic Leukaemia (Epidemiology (It is the accumulation of…
Chronic Lymphocytic Leukaemia
Epidemiology
It is the accumulation of mature B cells that have escaped programmed cell death and undergone cell-cycle arrest
Mutations, trisomies and deletions influence risk
Occurs predominantly in later life
Pneumonia may be a triggering event
The most common leukaemia
Clinical Presentation
If severe then weight loss, sweats and anorexia
Hepatosplenomegaly
May be anaemic (due to haemolytic or marrow infiltration) or infection prone
Enlarged, rubbery, non-tender nodes
Often no symptoms, presenting as a surprise on a routine FBC (done pre-op)
Diagnosis
Blood count
Normal or low Hb
Raised WCC with very high lymphocytes
Blood film
Smudge cells may be seen in vitro
Complications
Increased infection risk due to hypogammaglobinaemia; bacterial and viral especially herpes zoster
Marrow failure
Autoimmune haemolysis
Progression
Death is often due to complication of infection
May transform into aggressive lymphoma = Richter's syndrome
Many stay stable for years and may even regress
Treatment
Human IV immunoglobulins
Chemotherapy or radiotherapy
Blood transfusions
Try stem cell transplant
Prognosis
Rule of 3's
1/3 progress slowly
1/3 progress actively
1/3 will never progress