MEDizzy - A 74-year-old woman with a past history of chronic

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Combined Hematology

A 74-year-old woman with a past history of chronic lymphocytic leukemia presents with lethargy. The following blood results are obtained: Hb 7.9 g/dl Plt 158 * 109/l WCC 24.0 * 109/l Blood film: normochromic, normocytic anaemia What complication has most likely occurred?

ExplanationD. Warm autoimmune haemolytic anaemia occurs in around 10-15% of patients with chronic lymphocytic leukaemia CHRONIC LYMPHOCYTIC LEUKAEMIA Chronic lymphocytic leukaemia (CLL) is caused by a monoclonal proliferation of well-differentiated lymphocytes which are almost always B-cells (99%). It is the most common form of leukaemia seen in adults. Features • often none • constitutional: anorexia, weight loss • bleeding, infections • lymphadenopathy more marked than CML Complications • anaemia • hypogammaglobulinaemia leading to recurrent infections • warm autoimmune haemolytic anaemia in 10-15% of patients • transformation to high-grade lymphoma (Richter's transformation) Investigations • blood film: smudge cells (also known as smear cells) • immunophenotyping