• CLL is most common in male patients over the age of 60. It is caused by the proliferation of functionally incompetent malignant B cells.

PC

CLL typically presents asymptomatically. However, patients may present with:

• non-tender lymphadenopathy
• hepatosplenomegaly
• B symptoms (weight loss, night sweats, and fever).
• Features of marrow failure (infection, anaemia, and bleeding) are less common than in the acute leukaemias.

Investigations

• FBC - normal or low Hb, raised WCC, lymphocytosis, normal or low platelets
• blood film - small or medium sized mature and normal appearing lymphocytes, smudge cells may be seen
• Immunophenotyping - CD19+, CD5+ or CD23+ B cells with weak expression of CD22, CD79b and surface immunoglobulin
• Direct Coombs’ test may be positive if there is haemolysis.
• Immunoglobulins are low or normal.

Management

Depends on disease stage

• early-stage disease is usually managed expectantly
• advanced stage disease is always treated immediately