Chronic Lymphocytic Leukaemia Flashcards Preview

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Flashcards in Chronic Lymphocytic Leukaemia Deck (50)
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1

What is chronic lymphocytic leukaemia?

A monoclonal expansion of B-lymphocytes with accumulation of abnormal lymphocytes

2

Where do abnormal lymphocytes accumulate in chronic lymphocytic leukaemia?

- Blood
- Bone marrow
- Spleen
- Lymph nodes
- Liver

3

How do the lymphocytes in CLL appear morphologically?

Normal

4

What is abnormal about the lymphocytes in CLL?

They are immature and non-reactive

5

What is the result of the lymphocytes being immature and non-reactive in CLL?

Results in immunological compromise

6

How common is CLL compared to other leukaemias?

It represents about 1/4 of all leukaemias seen in clinical practice

7

When does CLL present?

It is largely a disease of older people

8

What causes CLL?

Unknown

9

What are the known risk factors for CLL?

- Age
- Radiation exposure

10

Are people in the UK exposed to radiation levels high enough to increase the risk of CLL?

No, it occurs after nuclear accidents etc

11

Describe the presentation of CLL?

Variable, with insidious onset

12

Are most people symptomatic at presentation of CLL?

No

13

How are people diagnosed with CLL asymptomatically?

Following routine blood tests

14

What are the symptoms of CLL?

- Susceptibility to infection
- Symmetrically enlarged lymph nodes
- Abdominal discomfort from an enlarged spleen
- Bleeding or petechiae in skin or mucous membranes

15

What are the signs of CLL?

- Localised or generalised lymphadenopathy
- Splenomegaly
- Hepatomegaly
- Petechiae
- Pallor
- Skin infiltration
- Tonsillar enlargement

16

What are the differential diagnoses for CLL?

- Other forms of leukaemia
- Lymphoma
- Myelodysplasia and myeloproliferative diseases

17

What investigations should be done in CLL?

- Blood tests
- Lymph node biopsy
- Other tests

18

What blood tests should be done in CLL?

- FBC
- Peripheral blood smear
- Direct anti-globulin test
- Bone marrow aspirate

19

What is found on FBC in CLL?

- Minimal clonal B cell lymphocytosis
- Normochromic, normocytic anaemia in advanced diseaes

20

What is found on peripheral blood smear in CLL?

Lymphocytosis, often with smudge cells

21

Why is a direct anti globulin test required in CLL?

Required before treatment to identify autoimmune-related haemolytic anaemias

22

What is found on bone marrow aspirate in CLL?

Lymphocytic replacement of normal marrow elements

23

When is a lymph node biopsy required in CLL?

If lymph nodes enlarge rapidly

24

Why is a lymph node biopsy required in CLL if lymph nodes enlarge rapidly?

To assess the possibility of transformation to a high-grade lymphoma

25

What is Richter's syndrome?

The transformation of CLL into a high grade-lymphoma with enlarged lymph nodes, fever, weight loss, and pain

26

What other tests may be done in CLL?

- Immunophenotyping
- Measurement of immunoglobulin levels if repeated infection
- Testing for TP53 gene deletion before treatment
- Status of relevant infections

27

What infections should you check for in CLL?

- Hep B and C
- Cytomegalovirus

28

When should you check for hep B and C and cytomegalovirus in CLL?

Before chemo-immunotherapy or stem cell transplantation

29

What staging system is used for CLL in Europe?

Binet system

30

What is stage A CLL?

- Hb at least 10g/L
- Platelets at least 100x109/L
- Fewer than 3 lymph nodes areas are involved