Additional methods of examination

Clinical blood analysis:

- the number of blood cells is usually between 50x10⁹/l and 300x10⁹/l;

- the number of red blood cells decreased;

- the number of platelet decreased;

- ESR accelerated;

- complete spectrum of myeloid cells is seen: blast cells, myelocytes, metamyelocytes, band cell, nature polymorphonuclear neutrophils;

- myeloblasts are usually less than 10 %;

- increased count of eosinophils and basophils.

Bone marrow:

• hypercellular with granulopoietic predominance;

- Phyladelphia chromosome in bone marrow cells is detected during cytogenetic analysis.

Chronic lymphocytic leukemia

Chronic lymphocytic leukemia is now regarded as a tumor of the immunocompetent lymphatic tissue.

Etiology

Some environmental factors such ionizing radiation, mutagenic chemicals have been implicated at the onset of disease.

Pathogenesis

The cause of disease is mutation of cell - precursors of lymphopoiesis with formation of lymphoid hyperplasia. This disease is characterized by the presence of increased number of small, normal-looking lymphocytes in the blood, bone marrow and lymphoid tissue. Over 90 % of all cases are caused by B-cells, the remaining are T-cells. Lymphocytes morphologically mature, but functionally inadequate. Immunological failure occurs from reduced humoral and cellular immune processes. Lymphoid infiltration of the organs and tissue (lung, brain, spleen, liver, skin) leads to clinical features. Generalized hyperplasia of lymphoid organs causes the main signs of disease.

Clinical features

Chronic lymphocytic leukemia is a disease of middle-aged and elderly persons. There is peak occurrence between 50 and 60 years of age. This disease has slowly onset with non specific complatains on loss of weight, decreased appetite and fatigue. The first specific clinical finding at the beginning of the disease is symmetrical, discrete, non tender peripheral lymphadenopathy, which observes at about 80 % patients. Palpation is used to assess the enlargement of the lymph nodes and their properties. The lymph nodes are elastic, they do not fuse with the skin or with one another; they are painless in most cases. The lymph nodes never ulcerate or suppurate.

Under condition of benign process the initial stage may last for a long time. As the disease progresses the peripheral lymph nodes become enormous, firm. Lymphadenopathy processes becomes generalized character with involvement of cervical, submandibular, supraclavicular, axillary, inguinal lymph nodes. They fuse together with formation of conglomerates. Dyspnea and attacks of asphyxia are observed related lo the enlargement of mediaslinal lymph nodes and compression of trachea and bronchi. Diffuse swelling of the neck and face may occur with obstruction of the superior vena cava due to lymphous. Enlarged mesenterial lymph nodes cause compression of vena cava. Abdominal fullness, belching discomfort, abdominal pain may arise from intestinal obstruction by lymph nodes. Pronounced enlarged lymph nodes may obstruct the gallbladder, urinary tract, upper respiratory tract.

The progression of the disease is characterized by high temperature, intoxication, dispnoe, skin itching. In some patients may observe the appearance on skin the specific signs - lymphoma and non-specific signs such as herpetic lesions, weals. Widespread erythroderma occurs in some cases. Skin leukemic lymphoderma on the face made in like ”lion face”.

Affection of the gastro-intestinal tract by lymphoid infiltration: dyspepsia, diarrhea. The fiver and the spleen are enlarged and consolidated. Infraction of the spleen can occur; its palpation then becomes tender.

There may be an increased incidence of bacterial, viral or fungal infections due to a lack of functional white blood cells.

In thrombocytopenic patients appear bruising or purpura. Features of anemia are pallor skin and mucosa, tachycardia.

At terminal stages observe bleeding complications, intoxication, hyperthermia, heart and renal failure.