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Laboratory features

Authoring team

  • peripheral blood:
    • WBC
    • WBC usually greater than 15000 x 10^9 per litre, may be markedly elevated
    • 75-98% of circulating cells may be lymphocytes
    • lymphocyte count is more than 5 x 10^9/l (1)
    • in blood smear, majority of lymphocytes are small, mature appearing with scanty cytoplasm, clumped chromatin, indistinct or absent nucleoli (1,2)
    • red blood cells - distinguish anaemia secondary to bone failure from that due to autoimmune haemolytic anaemia
    • platelets - usually normal; may be low secondary to bone marrow failure or to autoimmune thrombocytopenia
  • peripheral blood flow cytometry
    • most valuable test for the confirmation of CLL
    • immunophenotyping should be carried out in all patients who require treatment and is especially important in the following situations
      • in patients with low lymphocyte counts (to confirm the diagnosis of CLL and to exclude reactive lymphocytosis)
      • in patients with atypical lymphocyte morphology (to exclude other B- or T-cell lymphoproliferative disorders) (2)
    • classical immunophenotype of CLL are weak monotypic surface immunoglobulin, CD5, CD19, and CD23 and weak or absent CD79B, CD22 and FMC7 (2)

Additional investigations which could be done include:

  • bone marrow aspiration / biopsy - infiltration by lymphocytes
    • bone marrow examination is not carried out routinely except in cases where it is necessary
    • when there is diagnostic difficulty
    • as a prognostic indicator
    • to document the response to therapy
    • to assess haemopoietic reserve
    • as a research investigation (1)
  • Coomb's test (direct antiglobulin test ,DAT)
    • positive in 5% of patients
    • should be done in all anaemic patients and before commencing therapy (2)
  • serum Ig's - hypogammaglobulinaemia seen in two-thirds of cases dependent on duration of disease; monoclonal gammopathy - often IgM - seen in some cases
  • uric acid - often normal; may become elevated with treatment
  • imaging - chest X-ray, ultrasound of the abdomen (3)

Reference:


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