Determining whether the cause of the lymphocyte increase is benign or malignant is critical to determining appropriate treatment. New treatments are on the horizon.
| emphasize |
|
• this lymphocytosis It is usually caused by a transient viral infection, but may also persist in chronic infections (hepatitis B, hepatitis C, HIV, or tuberculosis) and chronic lymphocytic leukemia (CLL).
• Lymphocytosis should always be monitored and investigated, including a complete differential blood count, blood smear, and lymph node and abdominal examination.
• this chronic lymphocytic leukemia (CLL) Diagnosed when ≥5.0×109/L Monoclonal B lymphocytes (confirmed by flow cytometric immunophenotyping) and blood smear confirm lymphocytosis, small mature leukemia cells.
• strategy adopted observe When treating patients with CLL who have asymptomatic, inactive disease. Chemoimmunotherapy is recommended when patients have active symptomatic disease.
• Identification of genetic mutations is important in guiding optimal treatment and helps inform prognosis.
|
Lymphocytosis is defined as a lymphocyte count ≥5.0 x 109/L is usually caused by a transient viral infection.
Lymphocytosis can also be seen in chronic diseases (hepatitis B, hepatitis C, HIV, and tuberculosis) and chronic lymphocytic leukemia (CLL). Therefore, lymphocytosis (figure 1). When the lymphocyte count continues to be elevated, help from a hematology specialist is needed.
this chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world, with a median age at diagnosis of 70 years. CLL involves malignant monoclonal expansion of B lymphocytes and progressive infiltration of lymph nodes and hematopoietic sites, including the liver, spleen, and bone marrow. Therefore, depending on the extent of disease progression, patients may develop lymphadenopathy, hepatosplenomegaly, and cytopenias.
Lymphocytes in chronic lymphocytic leukemia (CLL) appear morphologically to be small and mature but are often unresponsive and dysfunctional, resulting in susceptibility to infections caused by hypogammaglobulinemia. People with CLL rarely experience the classic “B symptoms” such as night sweats, fever, and weight loss. In fact, most diagnoses are confirmed by the incidental finding of lymphocytosis during routine blood tests.
figure 1. Referral pathways for patients with lymphocytosis.
A complete examination of the cervical, axillary, and inguinal lymph nodes should be performed, and the abdomen should be examined for signs of hepatosplenomegaly, which is seen in approximately 50% of cases.
Symptoms of bone marrow failure may appear as petechiae or pallor. If a patient develops any of the above signs and has a confirmed lymphocytosis and no recent viral infection, urgent referral to a hematology department is required (figure 1).
If chronic lymphocytic leukemia (CLL) is suspected, the first test required is a complete blood count, which shows a white blood cell value Lymphocytes ≥5.0×109/L, indicating the need for a blood smear to assess morphology and confirm lymphocytosis. Flow cytometry will be performed to confirm the clonality of circulating B lymphocytes.
this immunophenotypic markers Characteristics of CLL include CD5, CD19, CD20 and CD23. These cells are immature and fragile and are damaged during slide preparation, producing the characteristic stained cells seen in smears. Total presence ≥5.0 x 109/L monoclonal B lymphocytes and these characteristic microscopic findings establish the diagnosis of CLL.
Fluorescent cytogenetic analysis is necessary to detect deletions on chromosome 17 (del17p), the short arm containing the TP53 gene, and gene sequencing to identify coding mutations. This is a tumor suppressor gene, often called the “guardian of the genome,” whose deletion or mutation is associated with lower treatment response rates and shorter progression-free survival. Identification of del17p or the presence of TP53 mutations is key to guide treatment options and helps inform prognosis.
this lactate dehydrogenase (LDH) and direct antiglobulin test (TAD) is a practical survey of patients with anemia that may help identify patients with anemia Autoimmune-related hemolytic anemia (AHAI) may complicate chronic lymphocytic leukemia (CLL) and should warrant immediate clinical review.
this immune thrombocytopenic purpura (ITP) is another autoimmune complication of chronic lymphocytic leukemia (CLL) that can lead to severe thrombocytopenia.
In patients with recurrent infections, immunoglobulin levels should be monitored for the presence of hypogammaglobulinemia. Hepatitis B, hepatitis C, cytomegalovirus, and HIV status should be determined before any chemo-immunotherapy to prevent viral reactivation.
Although bone marrow biopsy They are not necessary for a formal diagnosis of chronic lymphocytic leukemia (CLL) but are useful when the diagnosis is unclear and, if necessary, to determine response to treatment.
this CT examination Neck, chest, abdomen, and pelvis (CT) are often performed as part of the workup before chemoimmunotherapy. Imaging can assess tumor burden and determine the risk of tumor lysis syndrome.
Where lymph nodes are growing rapidly, a lymph node biopsy can help determine whether chronic lymphocytic leukemia (CLL) may transform into chronic lymphocytic leukemia (CLL). high-grade B-cell lymphoma.This process is called “Richter Transformation”patients often report symptoms of fever and weight loss.