Identify the abnormality in the picture. Give the diagnosis. This patient was asymptomatic and this abnormality was found on routine blood work-up. What is the next line of management?
Photo-quiz
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Identify the abnormality in the picture. Give the diagnosis. This patient was asymptomatic and this abnormality was found on routine blood work-up. What is the next line of management?
CLL usually has no symptoms in early stages..its found only incidentally by lymphocytosis and on peripheral smear in these stages..And later on patients present with fatigue and lymphadenopathy...Severe cases present with anemia and thrombocytopenia manifestations(Ref- CMDT 2010)
Anybody answering abt the management of this patient?
Anybody answering abt the management of this patient?
Mangement guided by-
Rai classification system
# stage 0, lymphocytosis only
# stage I, lymphocytosis plus lymphadenopathy
# stage II, organomegaly
# stage III, anemia
# stage IV, thrombocytopenia
Most cases of early indolent CLL require no specific therapy, and the standard of care for early stage disease has been observation.
Indications for treatment include progressive fatigue, symptomatic lymphadenopathy, or anemia or thrombocytopenia
symptomatic and progressive Rai stage II disease or stage III/IV disease-initial treatment of choice is the combination of the chemotherapeutic agent fludarabine plus the antibody rituximab, with or without the addition of the chemotherapeutic drug cyclophosphamide
In the case given, the patient is asymptomatic and only has lymphosytosis-->stage 0-->no intervention, observation is the answer...
Ref-CMDT 2010
Rai classification system
# stage 0, lymphocytosis only
# stage I, lymphocytosis plus lymphadenopathy
# stage II, organomegaly
# stage III, anemia
# stage IV, thrombocytopenia
Most cases of early indolent CLL require no specific therapy, and the standard of care for early stage disease has been observation.
Indications for treatment include progressive fatigue, symptomatic lymphadenopathy, or anemia or thrombocytopenia
symptomatic and progressive Rai stage II disease or stage III/IV disease-initial treatment of choice is the combination of the chemotherapeutic agent fludarabine plus the antibody rituximab, with or without the addition of the chemotherapeutic drug cyclophosphamide
In the case given, the patient is asymptomatic and only has lymphosytosis-->stage 0-->no intervention, observation is the answer...
Ref-CMDT 2010
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Smudge cells are ruptured CLL cells right? Are there any other kind of smears that would look similar to this CLL diagnosis? Or is this unique to only CLL?
ya they are due to rupture of fragile lymphocytes during preparation of slide..this phenomenon can be seen in reactive lymphocytosis, seen in some infections...but for exam purpose, its hallmark of CLL(this is seen more frequently in this because of fragility/membrane disorder)
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