Question

Hematology Leukemia Case Study #2. I would like an explanation too, so I can understand the information better. Thank you!

A 67-year-old male went to his doctor for a routine well check-up. A CBC was ordered: WBC count 25.6 x 10°/L Segs 18% Lymphs 75% Monos 1% Bands 6% Smudge cells noted on blood smear. This patient likely has: a) acute prolymphocytic leukemia b) acute lymphocytic leukemia c) Hairy cell leukemia d) chronic lymphocytic leukemia

Answer 1

Correct option is .d.
chronic lymphocytic leukaemia. Cll

Generally smudge cell are indicative of Cll. It occurs more commonly in elderly.
Acute lymphocytic leukaemia occurs in children .

let me explain u all about Cll

CHRONIC LYMPHOCYTIC LEUKAEMIA/ SMALL LYMPHOCYTIC LYMPHOMA (B-CELL CLL/SLL)
As the name implies, this subtype may present as leukaemia or lymphoma constituting 9% of all lymphoid neoplasms. As lymphoid leukaemia (CLL), this is the most common form while as SLL it constitutes 7% of all NHLs. B-cell CLL/SLL occurs more commonly in middle and older age groups (over 50 years of age) with a male preponderance (male-female ratio 2:1).
Clinical Features
The condition may remain asymptomatic, or may have an insidious onset and may present with nonspecific clinical features. Common presenting manifestations are as under:
1. Features of anaemia such as gradually increasing weakness, fatigue and dyspnoea.   
2. Enlargement of superficial lymph nodes is a very common finding. The lymph nodes are usually symmetrically enlarged, discrete and non-tender.
3. Splenomegaly and hepatomegaly are usual.
4. Haemorrhagic manifestations are found in case of CLL withthrombocytopenia.
5. Susceptibility to infections, particularly of respiratory tract, is common in CLL.
6. Less common findings are: mediastinal pressure, tonsillar enlargement, disturbed vision, and bone and joint pains.

Morphologic Features
The diagnosis of CLL can usually be made on the basis of physical findings and blood smear examination
I. BLOOD PICTURE The findings of routine blood picture are as under:
1. Anaemia Anaemia is usually mild to moderate and normocytic normochromic in type. Mild reticulocytosis may be present. About 20% cases develop a Coombs’-positive autoimmune haemolytic anaemia.
2. White blood cells Typically, there is marked leuco- cytosis but less than that seen in CML (50,000-200,000/ μl). Usually, more than 90% of leucocytes are mature small lymphocytes. Smudge or basket cells (degenerated forms) are present due to damaged nuclei of fragile malignant lymphocytes. The absolute neutrophil count is, however, generally within normal range. Granulocytopenia occurs when disease is fairly advanced.
3. Platelets The platelet count is normal or moderately reduced as an autoimmune phenomenon.
II. BONE MARROW EXAMINATION The typical findings are as under:
1. Increased lymphocyte count (25-95%).
2. Reduced myeloid precursors.
3. Reduced erythroid precursors.
III. LYMPH NODE BIOPSY Cases with lymphadeno- pathy at presentation show replacement of the lymph node by diffuse proliferation of well-differentiated, mature, small and uniform lymphocytes without any cytologic atypia or significant mitoses . These cells are of monoclonal B-cell origin having immunologic features of mantle zone B-cells.
IV. OTHER INVESTIGATIONS These include the following:
1. Erythrocyte rosette test with mouse red cells is positive in more than 95% of cases indicating that CLL is a monoclonal B cell neoplasm.
2. Positive for B-cell markers e.g. typically CD5 positive; other pan-B cell markers are CD19, CD20, CD23, surface immunoglobulins of various classes, monoclonal light chains (l or k type).
3. Serum immunoglobulin levels are generally reduced. 4. Coombs’ test is positive in 20% cases.
5.Cytogenetic abnormalities, most commonly trisomy 12 seen in about 25% case