Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Chronic Lymphocytic Leukemia 333

Chronic Lymphocytic Leukemia.........................

KANTI R. RAI, MD

history & physical

History

■Characteristically, a disease of elderly

■Predominant in males

Signs & Symptoms

■Often diagnosed in an asymptomatic patient on routine CBC

■Usually has an indolent course

■Patients may present with “B” symptoms and abdominal fullness

(secondary to splenomegaly)

■Physical exam may be normal at initial diagnosis

➣Some patients may have some or all of the following: pallor, lym-

phadenopathy, splenomegaly, skin involvement

tests

Essential Criteria for Diagnosis

■Absolute lymphocytosis (≥5,000/microliter) persistent for >4 weeks

■More than 30% involvement of the bone marrow by CLL

■Characteristic phenotypic profile of the lymphocytes on flow

cytometry: CD5(+), CD19(+), CD20(+), CD23(+), dim expression

of monoclonal surface immunoglobulin

Other Lab Findings

■Absolute lymphocytosis with mature appearing lymphocytes in

peripheral blood

■Anemia, thrombocytopenia may be seen

■Hypogammaglobulinemia may be seen

Bone Marrow

■Hypercellular or normocellular

■Marked lymphoid infiltration

■Flow cytometry: as above

differential diagnosis

■Other lymphoproliferative disorders (see table)