Chronic lymphocytic leukaemia

What it is

Chronic lymphocytic leukemia is an indolent B cell lymphoma, grouped with the non-Hodgkin lymphomas alongside follicular lymphoma, lymphoplasmacytic lymphoma and hairy cell leukemia.

How it presents

It can carry immune dysregulation, which shows as autoimmune hemolytic anemia or ITP. The one most commonly associated with it is warm autoimmune hemolytic anemia. Enlarged nodes, splenomegaly and hepatomegaly appear as the stage rises, and anemia and a low platelet count come last.

How it is diagnosed

Flow cytometry of peripheral blood is the diagnostic test of choice, and it is sufficient on its own: bone marrow biopsy is not required for the diagnosis of CLL.

The blood film shows monomorphic small lymphocytes with a soccer ball appearance and many smudge cells. A smudge cell is a lymphocyte damaged during blood film preparation, so it indicates cell fragility, and it is seen in CLL and other lymphoproliferative disorders.