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Chronic Lymphocytic Leukemia

Chronic 2

Step 1: View clinicals

A 72 year old woman presents with progressive, bilateral hearing loss for 1 year. She was treated for bilateral otitis media earlier, which included placement of myringotomy tubes. However, her symptoms have not improved. Close questioning reveals a history of chronic fatigue and dyspnea on exertion for more than 2 years, which she attributed to old age. Her medical, surgical and family histories are unremarkable and she is not on any medications currently. Her complete blood count reveals a leukocyte count of 85,600 with 80% lymphocytes, a hemoglobin level of 10.9 g/dL, and a platelet count of 130,000/mm3. A peripheral blood film reveals lymphocytosis, thrombocytopenia and smudge cells.

Step 2: Order all relevant investigations

Flow Cytometry

Flow Cytometry shows the peripheral blood lymphocytes to be positive for the B-cell markers CD19, CD20, with co-expression of the T-cell markers CD5 and CD23. They are negative for CD10, Cyclin-D, FMC7, and CD79b.

Bone Marrow Aspiration and Biopsy

Bone marrow studies reveal central nodules of mature-appearing lymphocytes, with a diffuse background infiltrate intimately admixed with the hematopoietic tissue; this is consistent with B-cell Chronic Lymphocytic Leukemia (CLL).

Biopsy Tympanic Membrane

The biopsy demonstrates infiltration with mature-appearing lymphocytes consistent with CLL.

CSF Analysis

Cerebrospinal Fluid analysis demonstrates the presence of clonal lymphocytes; immunohistochemical studies reveal that approximately 80% of cells are positive for the B-cell marker CD20.

Step 3: Select appropriate management

Blood Transfusion
Prophylactic Antibiotics
Systemic Chemotherapy
Allogeneic Stem Cell Transplant

Score: ★★☆