Case Studies

 Case 6.2 Chronic lymphocytic leukaemia

A 62-year-old man presented with increasing shortness of breath on exercise and loss of weight. He had suffered five chest infections during the previous winter, despite being a non-smoker. On examination, there was moderate, bilateral cervical lymphadenopathy and left inguinal lymph node enlargement. The spleen and liver were enlarged 5cm below the costal margins. There was no bone tenderness and there were no lesions in the skin. On investigation, his haemoglobin (132g/l) and platelet count (251 x 10⁹/l) were normal but his white-cell count was increased to 150 x 10⁹/l; the film showed that 98% of these were small lymphocytes.

The features on the blood film were suggestive of chronic lymphocytic leukaemia and immunophenotyping confirmed this diagnosis (Table C6.2). Ninety per cent of the cells were B cells; they all expressed surface immunoglobulin (mu, delta and kappa chains), major histocompatibility complex class II antigens (DR) and CD5. The serum immunoglobulins were low: IgG 2.2g/l (NR 7.2-19.0g/l); IgA 0.6g/l (NR 0.8-5.0g/l) and IgM 0.4g/l (NR 0.5-2.0g/l). There was no monoclonal immunoglobulin in the serum or the urine.

Table C6.2 Immunophenotyping in Cases 6.2, 6.3 and 6.4.

*Results expressed as percentage of peripheral blood lymphocytes positive for marker.