Page 250 - Essential Haematology

236 / Chapter 18 Chronic lymphoid leukaemias

Figure 18.1 Chronic lymphocytic leukaemia: bilateral Figure 18.2 Chronic lymphocytic leukaemia: herpes

cervical lymphadenopathy in a 67 - year - old woman. zoster infection in a 68 - year - old female.
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Haemoglobin 12.5 g/dL; white blood count 150 × 10 /L

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(lymphocytes 146 × 10 /L); platelets 120 × 10 /L.

Figure 18.3 Chronic lymphocytic

leukaemia: peripheral blood fi lm
showing lymphocytes with thin
rims of cytoplasm, coarse
condensed nuclear chromatin and
rare nucleoli. Typical smudge
cells are present.

4 Features of anaemia may be present. Patients Laboratory fi ndings
with thrombocytopenia may show bruising or
purpura. 1 Lymphocytosis. The absolute clonal B cell lym-

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5 Splenomegaly and, less commonly, hepatomegaly phocyte count is > 5 × 10 /L and may be up to
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are common in later stages. 300 × 10 /L or more. Between 70 and 99% of
6 Immunosuppression may be a signifi cant problem white cells in the blood film appear as small

resulting from hypogammaglobulinaemia and lymphocytes. Smudge or smear cells are also
cellular immune dysfunction. Early in the disease present (Fig. 18.3 ).
course bacterial infections predominate but with 2 Immunophenotyping of the lymphocytes shows
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advanced disease viral and fungal infections such them to be B cells (surface CD19 ), weakly
as herpes zoster are also seen (Fig. 18.2 ). expressing surface immunoglobulin (IgM or