Chronic Lymphocytic Leukemia, a Case Report

Chronic lymphocytic leukemia,(CLL), is a heterogeneous disease, clinically characterized by the accumulation and expansion of a clone population of mature B lymphocytes in blood, bone marrow and lymphoid organs. Initial, genetic events are primarily responsible for the first stage of malignancy transformation and the processes of development and progression of CLL clone are considered to be modulated by signals of different micro-cellular environment, which regulates cell proliferation and survival of malignant B cells. CLL is characterized by a progressive of antigen-stimulated mature B lymphocytes in blood, bone morrow and secondary lymphoid tissues. CLL is considered to be identical with small lymphocytic lymphoma (SLL), with different tissues manifestations. SLL is a term used when the malignant cells infiltrate solid tissue without overt leukemia in the blood. CCL occurs in middle aged and elderly person, affecting men to women in approximately 2;1. Many patients are asymptomatic when the disease is diagnosed. Patients with minimal evidence of disease, ie, lymphocytosis only, are considered to be early stage of disease, while those demonstrating compromise of bone morrow function as anemia or thrombocytopenia, are in advanced stages. Ray system has been modified to degree risk: stage „0”, low risk, stage I and II intermediate risk and stage III and IV high risk. Stage ‘0’means lymphocytosis in blood and bone morrow only, stage I lymphocytosis plus enlarged lymph node, stage II lymphocytosis plus enlarged liver/and or spleen; lymphadenopaty may be present, stage III lymphocytosis plus anemia(hemoglobin< 11d/dl, lymph node, spleen or liver may be enlarged and stage IV with lymphocytosis and thrombocytopenia, PLT < 100 x10³ /mm³, anemia or organomelia may be present. Approximate, survival time in these 3 categories are greater in than 10, 6 and 2 years, respectively. The Binet staging system is also effective in predicting prognosis, with median survival, ranging > 120 month in stage A, 61 month in stage B, and 32 months in stage C. Stage A means Hb > 10g/dl, PLT < 100 x 10³/mm³,< 3 anatomic sites implicated; Stage B, Hb > 10g/dl, PLT > 100 x 10³/mm³,> 3 anatomic sites implicated and stage C, Hb 500 x10³/mm³ may occurs in late stage of the disease, hemolytic anemia occurs in case of complicated disease LLC with autoimmune hemolytic anemia , with reticulocytosis . The leukocyte count varues but most patients leucocytosis , 30 x 10³m//³ The FAB group proposed 2 subtypes of LLC: subtype with small and large lynphocytes and subtype with increased pro-lymphocytes, approximately 10%-15%. In most case of CLL, lympfopcytes appears small with condensed chromatin pattern, and narrow rims of scant cytoplasm. The lymphocytes tend to resemble one another. Smudged or damaged lymphocytes often are prominent in the smear. (Bennet JM, Daniel MT.