Chronic lymphocytic leukemia laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Chronic lymphocytic leukemia}} | {{Chronic lymphocytic leukemia}} | ||
{{CMG}} {{AE}}{{HL}} | {{CMG}} {{shyam}} {{AE}}{{HL}} | ||
==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of chronic lymphocytic leukemia include abnormal complete blood count, immunohistochemistry, and electrophoresis. | Laboratory findings consistent with the [[diagnosis]] of chronic lymphocytic leukemia include [[abnormal]] [[complete blood count]], [[immunohistochemistry]], and [[electrophoresis]]. Monoclonality of kappa and [[Lambda (anatomy)|lambda]] producing [[B cell]]s is a key [[Diagnosis|diagnostic]] feature among [[Patient|patients]] with chronic lymphocytic leukemia. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
===Complete Blood Count=== | ===Complete Blood Count=== | ||
* Absolute lymphocytosis | * Absolute [[lymphocytosis]] ≥5000 B-[[Lymphocyte|lymphocytes]]/µL X ≥ 3 months<ref name="pmid29540348">{{cite journal |vauthors=Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating M, Montserrat E, Chiorazzi N, Stilgenbauer S, Rai KR, Byrd JC, Eichhorst B, O'Brien S, Robak T, Seymour JF, Kipps TJ |title=iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL |journal=Blood |volume=131 |issue=25 |pages=2745–2760 |date=June 2018 |pmid=29540348 |doi=10.1182/blood-2017-09-806398 |url=}}</ref><ref name="pmid4052958">{{cite journal |vauthors=Baer MR, Stein RS, Dessypris EN |title=Chronic lymphocytic leukemia with hyperleukocytosis. The hyperviscosity syndrome |journal=Cancer |volume=56 |issue=12 |pages=2865–9 |date=December 1985 |pmid=4052958 |doi= |url=}}</ref> | ||
* | * Decreased [[hemoglobin]] | ||
* | ** [[Autoimmunity|Autoimmune]] [[Hemolysis|hemolytic]] [[anemia]] ([[Autoimmune hemolytic anemia|AIHA]])<ref name="pmid9482530">{{cite journal |vauthors=Diehl LF, Ketchum LH |title=Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia |journal=Semin. Oncol. |volume=25 |issue=1 |pages=80–97 |date=February 1998 |pmid=9482530 |doi= |url=}}</ref> | ||
** Pure [[Red cells|red cell]] [[aplasia]]<ref name="pmid94825302">{{cite journal |vauthors=Diehl LF, Ketchum LH |title=Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia |journal=Semin. Oncol. |volume=25 |issue=1 |pages=80–97 |date=February 1998 |pmid=9482530 |doi= |url=}}</ref> | |||
* [[Thrombocytopenia]] | |||
** [[Immunity (medical)|Immune]] [[thrombocytopenia]] ([[Idiopathic thrombocytopenic purpura|ITP]])<ref name="pmid94825303">{{cite journal |vauthors=Diehl LF, Ketchum LH |title=Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia |journal=Semin. Oncol. |volume=25 |issue=1 |pages=80–97 |date=February 1998 |pmid=9482530 |doi= |url=}}</ref> | |||
** Pure [[Red cells|red cell]] [[aplasia]]<ref name="pmid94825302" /> | |||
===Blood Smear=== | ===Blood Smear=== | ||
* | * Presence of [[Smudge cells|smudge]] [[Cell (biology)|cells]]<ref name="pmid17418074">{{cite journal |vauthors=Nowakowski GS, Hoyer JD, Shanafelt TD, Geyer SM, LaPlant BR, Call TG, Jelinek DF, Zent CS, Kay NE |title=Using smudge cells on routine blood smears to predict clinical outcome in chronic lymphocytic leukemia: a universally available prognostic test |journal=Mayo Clin. Proc. |volume=82 |issue=4 |pages=449–53 |date=April 2007 |pmid=17418074 |doi=10.4065/82.4.449 |url=}}</ref> | ||
===Metabolic Panel=== | ===Metabolic Panel=== | ||
* Elevated low-density lipoprotein level | * Elevated [[low-density lipoprotein]] level | ||
===Quantitative Immunoglobulin Assay=== | ===Quantitative Immunoglobulin Assay=== | ||
* Quantitative measurement of IgA, IgG, and IgM | * [[Quantitative]] [[measurement]] of [[IgA]], [[IgG]], and [[IgM]] [[immunoglobulin]]s to detect [[hypogammaglobulinemia]]<ref name="pmid25931291">{{cite journal |vauthors=Parikh SA, Leis JF, Chaffee KG, Call TG, Hanson CA, Ding W, Chanan-Khan AA, Bowen D, Conte M, Schwager S, Slager SL, Van Dyke DL, Jelinek DF, Kay NE, Shanafelt TD |title=Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia: Natural history, clinical correlates, and outcomes |journal=Cancer |volume=121 |issue=17 |pages=2883–91 |date=September 2015 |pmid=25931291 |doi=10.1002/cncr.29438 |url=}}</ref> | ||
* Elevated β2-microglobulin level<ref name="pmid19483161">{{cite journal |vauthors=Gentile M, Cutrona G, Neri A, Molica S, Ferrarini M, Morabito F |title=Predictive value of beta2-microglobulin (beta2-m) levels in chronic lymphocytic leukemia since Binet A stages |journal=Haematologica |volume=94 |issue=6 |pages=887–8 |date=June 2009 |pmid=19483161 |doi=10.3324/haematol.2009.005561 |url=}}</ref> | |||
===Electrophoresis=== | ===Electrophoresis=== | ||
* | * Monoclonality of kappa and [[Lambda phage|lambda]] producing [[B cell]]s is a key [[Diagnosis|diagnostic]] feature among [[Patient|patients]] with chronic lymphocytic leukemia.<ref name="pmid26065657">{{cite journal |vauthors=Strati P, Shanafelt TD |title=Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification |journal=Blood |volume=126 |issue=4 |pages=454–62 |date=July 2015 |pmid=26065657 |pmc=4624440 |doi=10.1182/blood-2015-02-585059 |url=}}</ref> | ||
===Immunohistochemistry=== | ===Immunohistochemistry=== | ||
* Chronic lymphocytic leukemia cells typically express CD19, CD20, CD23, and CD5 on the cell surface.<ref name=" | * Chronic lymphocytic leukemia [[Cell (biology)|cells]] typically express [[CD19]], [[CD20]], [[CD23]], and [[CD5]] on the [[cell]] surface.<ref name="pmid29024461">{{cite journal |vauthors=Rawstron AC, Kreuzer KA, Soosapilla A, Spacek M, Stehlikova O, Gambell P, McIver-Brown N, Villamor N, Psarra K, Arroz M, Milani R, de la Serna J, Cedena MT, Jaksic O, Nomdedeu J, Moreno C, Rigolin GM, Cuneo A, Johansen P, Johnsen HE, Rosenquist R, Niemann CU, Kern W, Westerman D, Trneny M, Mulligan S, Doubek M, Pospisilova S, Hillmen P, Oscier D, Hallek M, Ghia P, Montserrat E |title=Reproducible diagnosis of chronic lymphocytic leukemia by flow cytometry: An European Research Initiative on CLL (ERIC) & European Society for Clinical Cell Analysis (ESCCA) Harmonisation project |journal=Cytometry B Clin Cytom |volume=94 |issue=1 |pages=121–128 |date=January 2018 |pmid=29024461 |pmc=5817234 |doi=10.1002/cyto.b.21595 |url=}}</ref><ref name="pmid295403482">{{cite journal |vauthors=Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating M, Montserrat E, Chiorazzi N, Stilgenbauer S, Rai KR, Byrd JC, Eichhorst B, O'Brien S, Robak T, Seymour JF, Kipps TJ |title=iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL |journal=Blood |volume=131 |issue=25 |pages=2745–2760 |date=June 2018 |pmid=29540348 |doi=10.1182/blood-2017-09-806398 |url=}}</ref> | ||
===Peripheral Blood Cytogenetics=== | |||
* Peripheral [[blood]] [[cytogenetics]] and [[FISH]] determine [[prognosis]] in [[Patient|patients]] with CLL. The most important [[Prognosis|prognostic]] feature is the presence of absence of del (17p), which leads to the loss of ''[[TP53]]'', a [[tumor]] suppressor [[gene]]. Presence of del ([[13q deletion syndrome|13q]]) is a favorable feature. Presence of del ([[11q deletion|11q]]) is an adverse [[Prognosis|prognostic]] feature.<ref name="PuiggrosBlanco2014">{{cite journal|last1=Puiggros|first1=Anna|last2=Blanco|first2=Gonzalo|last3=Espinet|first3=Blanca|title=Genetic Abnormalities in Chronic Lymphocytic Leukemia: Where We Are and Where We Go|journal=BioMed Research International|volume=2014|year=2014|pages=1–13|issn=2314-6133|doi=10.1155/2014/435983}}</ref> | |||
==References== | ==References== | ||
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[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Hematology]] | |||
[[Category:Immunology]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [3]
Overview
Laboratory findings consistent with the diagnosis of chronic lymphocytic leukemia include abnormal complete blood count, immunohistochemistry, and electrophoresis. Monoclonality of kappa and lambda producing B cells is a key diagnostic feature among patients with chronic lymphocytic leukemia.
Laboratory Findings
Complete Blood Count
- Absolute lymphocytosis ≥5000 B-lymphocytes/µL X ≥ 3 months[1][2]
- Decreased hemoglobin
- Thrombocytopenia
Blood Smear
Metabolic Panel
- Elevated low-density lipoprotein level
Quantitative Immunoglobulin Assay
- Quantitative measurement of IgA, IgG, and IgM immunoglobulins to detect hypogammaglobulinemia[7]
- Elevated β2-microglobulin level[8]
Electrophoresis
- Monoclonality of kappa and lambda producing B cells is a key diagnostic feature among patients with chronic lymphocytic leukemia.[9]
Immunohistochemistry
- Chronic lymphocytic leukemia cells typically express CD19, CD20, CD23, and CD5 on the cell surface.[10][11]
Peripheral Blood Cytogenetics
- Peripheral blood cytogenetics and FISH determine prognosis in patients with CLL. The most important prognostic feature is the presence of absence of del (17p), which leads to the loss of TP53, a tumor suppressor gene. Presence of del (13q) is a favorable feature. Presence of del (11q) is an adverse prognostic feature.[12]
References
- ↑ Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating M, Montserrat E, Chiorazzi N, Stilgenbauer S, Rai KR, Byrd JC, Eichhorst B, O'Brien S, Robak T, Seymour JF, Kipps TJ (June 2018). "iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL". Blood. 131 (25): 2745–2760. doi:10.1182/blood-2017-09-806398. PMID 29540348.
- ↑ Baer MR, Stein RS, Dessypris EN (December 1985). "Chronic lymphocytic leukemia with hyperleukocytosis. The hyperviscosity syndrome". Cancer. 56 (12): 2865–9. PMID 4052958.
- ↑ Diehl LF, Ketchum LH (February 1998). "Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia". Semin. Oncol. 25 (1): 80–97. PMID 9482530.
- ↑ 4.0 4.1 Diehl LF, Ketchum LH (February 1998). "Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia". Semin. Oncol. 25 (1): 80–97. PMID 9482530.
- ↑ Diehl LF, Ketchum LH (February 1998). "Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia". Semin. Oncol. 25 (1): 80–97. PMID 9482530.
- ↑ Nowakowski GS, Hoyer JD, Shanafelt TD, Geyer SM, LaPlant BR, Call TG, Jelinek DF, Zent CS, Kay NE (April 2007). "Using smudge cells on routine blood smears to predict clinical outcome in chronic lymphocytic leukemia: a universally available prognostic test". Mayo Clin. Proc. 82 (4): 449–53. doi:10.4065/82.4.449. PMID 17418074.
- ↑ Parikh SA, Leis JF, Chaffee KG, Call TG, Hanson CA, Ding W, Chanan-Khan AA, Bowen D, Conte M, Schwager S, Slager SL, Van Dyke DL, Jelinek DF, Kay NE, Shanafelt TD (September 2015). "Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia: Natural history, clinical correlates, and outcomes". Cancer. 121 (17): 2883–91. doi:10.1002/cncr.29438. PMID 25931291.
- ↑ Gentile M, Cutrona G, Neri A, Molica S, Ferrarini M, Morabito F (June 2009). "Predictive value of beta2-microglobulin (beta2-m) levels in chronic lymphocytic leukemia since Binet A stages". Haematologica. 94 (6): 887–8. doi:10.3324/haematol.2009.005561. PMID 19483161.
- ↑ Strati P, Shanafelt TD (July 2015). "Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification". Blood. 126 (4): 454–62. doi:10.1182/blood-2015-02-585059. PMC 4624440. PMID 26065657.
- ↑ Rawstron AC, Kreuzer KA, Soosapilla A, Spacek M, Stehlikova O, Gambell P, McIver-Brown N, Villamor N, Psarra K, Arroz M, Milani R, de la Serna J, Cedena MT, Jaksic O, Nomdedeu J, Moreno C, Rigolin GM, Cuneo A, Johansen P, Johnsen HE, Rosenquist R, Niemann CU, Kern W, Westerman D, Trneny M, Mulligan S, Doubek M, Pospisilova S, Hillmen P, Oscier D, Hallek M, Ghia P, Montserrat E (January 2018). "Reproducible diagnosis of chronic lymphocytic leukemia by flow cytometry: An European Research Initiative on CLL (ERIC) & European Society for Clinical Cell Analysis (ESCCA) Harmonisation project". Cytometry B Clin Cytom. 94 (1): 121–128. doi:10.1002/cyto.b.21595. PMC 5817234. PMID 29024461.
- ↑ Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating M, Montserrat E, Chiorazzi N, Stilgenbauer S, Rai KR, Byrd JC, Eichhorst B, O'Brien S, Robak T, Seymour JF, Kipps TJ (June 2018). "iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL". Blood. 131 (25): 2745–2760. doi:10.1182/blood-2017-09-806398. PMID 29540348.
- ↑ Puiggros, Anna; Blanco, Gonzalo; Espinet, Blanca (2014). "Genetic Abnormalities in Chronic Lymphocytic Leukemia: Where We Are and Where We Go". BioMed Research International. 2014: 1–13. doi:10.1155/2014/435983. ISSN 2314-6133.