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Heamatology > CLL > Flashcards

CLL Flashcards

1
Q

What is the definition of CLL

A

Chronic lymphocytic leukaemia - low grade B cell (type of white blood cell) lymphoma with lymphocytic leukocytosis

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2
Q

What is the median age of onset for CLL?

A

70-72 years of age

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3
Q

What is the most common type of leukaemia in adults?

A

CLL

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4
Q

What are the risk factors for CLL? (3)

A

Advanced age
Environment (organic solvents)
Family history

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5
Q

What is the classification system used to rank the CLL staging?

A

Rai staging system

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6
Q

What are the 5 stages of the Rai staging system?

A

0 - low risk - isolated lymphocytosis
1 - intermediate risk - + lymphadenopathy
2 - intermediate risk - + hepatomegaly and or splenomegaly
3 - high risk - + anaemia (Hb>11g/dl)
4 - high risk - + thrombocytopenia (<100,000/ micro litre)

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7
Q

What is thrombocytopenia? And what is a thrombocyte?

A

Low level of thrombocytes. It is a platelet.

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8
Q

What is the pathophysiology behind CLL?

A

Acquired mutations in hematopoietic stem cells -> increased proliferation of leukaemia B cells with impaired maturation and differentiation in bone marrow

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9
Q

What does impaired maturation of B cells in CLL lead to? (Clinical features)

A

Immune suppression
Hypogammaglobulinemia
Granulocytopenia
Thrombocytopenia
Anaemia
Infiltration of lymph nodes, liver and spleen

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10
Q

What are the symptoms and signs of CLL?

A

Weight loss
Fatigue
Fever
Night sweats
Painless lymphadenopathy
Hepatomegaly and or splenomegaly
Repeated infections
Symptoms of anemia (exertional dyspnoea, fatigue, pallor, growth impairment)
Chronic pruritis
Chronic urticaria (hives)

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11
Q

Which lab tests should be done for CLL?

A

CBC
Blood smear
Flow cytometry
Serum antibody electrophoresis
Bone marrow aspiration
Ultrasound
Lymph node biopsy

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12
Q

What will a CBC show for CLL?

A

Persistent lymphocytosis
Granulocytopenia
Low RBC count
Low platelet count

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13
Q

What will a blood smear show for CLL?

A

Smudge cells

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14
Q

What is a smudge cell?

A

Mature lymphocyte that ruptured easily and appears as an artefact in a blood smear

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15
Q

What will flow cytometry show for CLL?

A

Biomarkers for B cell development

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16
Q

What will bone marrow aspiration show for CLL?

A

High percentage of small, mature lymphocytes
Decreased number of myeloid progenitor cells

17
Q

What will an ultrasound show for CLL?

A

Hepatomegaly
Splenomegaly

18
Q

What is the purpose of a lymph node biopsy for CLL?

A

To differentiate between other diseases eg Hodgkin lymphoma

19
Q

What is the differential diagnosis for CLL?

A

Acute lymphoblastic leukaemia
Autoimmune hemolytic anaemia
Mantle cell lymphoma
Hairy cell lymphoma

20
Q

What is the treatment for stage 0 CLL?

A

Observe and monitor the progression

21
Q

What is the treatment if the CLL is stage >0?

A

Chemotherapy
Targeted therapy with ibutrinib
If CD20 biomarker is positive - use rituximab
Stem cell transplant in refractory CLL of young patients

22
Q

What are the complications of CLL?

A

Immunosuppression
Secondary malignancies
Hyper viscosity syndrome (impaired microcirculation of blood due to increased blood viscosity)
Autoimmune haemolytic anaemia
Increased LDH (enzyme that converts lactate to pyruvate)

23
Q

What is a myeloid progenitor cell?

A

Precursor to erythrocyte, platelet, mast cell and osteoclast

Heamatology (3 decks)

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