iatroX Rounds #41
The clues
- 1
A 68-year-old man presents to his GP after noticing several painless swellings in his neck that have been present for three months.
- 2
He reports feeling increasingly lethargic and has noticed he seems to bruise more easily than before, although he denies weight loss or night sweats.
- 3
His medical history includes hypertension and osteoarthritis, and he has never smoked or been exposed to industrial radiation.
- 4
Examination reveals firm, non-tender, rubbery lymphadenopathy in the cervical and axillary regions, and the splenic edge is palpable 3cm below the costal margin.
- 5
A full blood count shows a haemoglobin of 105 g/L, a platelet count of 115 x 10^9/L, and a total white cell count of 52 x 10^9/L with an absolute lymphocyte count of 46 x 10^9/L.
- 6
The peripheral blood film shows a monotonous population of mature small lymphocytes and numerous crushed-looking cells known as smudge cells or basket cells.
Chronic lymphocytic leukaemia is the most common leukaemia in the UK, typically affecting older adults. It is characterized by the progressive accumulation of functionally incompetent, mature B-lymphocytes in the blood, bone marrow, and secondary lymphoid organs.
- Often discovered as an incidental finding of isolated lymphocytosis on a routine full blood count
- Painless, symmetrical, and rubbery lymphadenopathy is a classic physical finding
- Patients may develop immune complications such as autoimmune haemolytic anaemia or hypogammaglobulinaemia
- Richter transformation into a high-grade non-Hodgkin lymphoma occurs in approximately 5 percent of cases
for education and entertainment. not medical advice.