78 Chronic Lymphocytic Leukemia (CLL)
Michelle To and Valentin Villatoro
-
- An image from a peripheral blood smear showing numerous small mature lymphocytes and smudge cells seen in a patient with CLL. 50X oil immersion. From MLS Collection, University of Alberta, https://doi.org/10.7939/R3SQ8QZ8C
-
- An image from a CLL peripheral blood smear showing a smudge cell (A) and mature small lymphocytes (B). 100x oil magnification. From MLS Collection, University of Alberta, https://doi.org/10.7939/https://doi.org/10.7939/R3DJ58X9R
Cell Features:1-4
Abundant small mature small lymphocytes
Scant Cytoplasm
Condensed/clumped chromatin (often described as “soccer ball” or “parched earth” appearance)
Cause:1-4
A mature B cell neoplasm with no specific agent or cause. Cytogenetic findings show relation to trisomy 12 and other chromosomal deletions.
Age group affected: Mainly older adults >50 years old.1,5,6
Laboratory Features for CLL:1,2,6
|
CBC: Normochromic, Normocytic Anemia Normal to Decreased reticulocyte count Neutropenia Thrombocytopenia |
PBS: Small mature lymphocytes Presence of smudge cells Platelet and granulocyte morphology is normal |
BM: Lymphocytic infiltration, reduced numbers of normal hematopietic cells |
|
Immunologic markers: CD5, CD19, CD20, CD23 |
Other useful tests: FISH PCR Associated with hypogammaglobulinemia |
|
References:
1. Holmer LD, Bueso-Ramos CE. Chronic lymphocytic leukemia and related lymphoproliferative disorders. In: Clinical hematology and fundamentals of hemostasis. 5th ed. Philadelphia: F.A. Davis Company; 2009. p. 440-65.
2. Czader M. Mature lymphoid neoplasms. In: Rodak’s hematology clinical applications and principles. 5th ed. St. Louis, Missouri: Saunders; 2015. p. 619-41.
3. Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG, et al. Chronic lymphocytic leukaemia. Nat Rev Dis Prim [Internet]. 2017 Jan 19 [cited 2018 Jun 27];3:16096. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336551/
4. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues Volume 2. 4th ed. International Agency for Research on Cancer (IARC); 2008.
5. McKenzie SB. Introduction to hematopoietic neoplasms. In: Clinical laboratory hematology. 3rd ed. New Jersey: Pearson; 2015. p. 424-45.
6. Turgeon ML. Malignant myeloid and monocytic disorders and plasma cell dyscrasias. In: Clinical hematology: theory and procedures. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999. p. 275-92.
