Fiji School of Medicine

1
CLL in Transformation
COW Case of the Week

• Fiji School of Medicine
• CWM Hospital.

2
Clinical History

• 60Year Fiji Indian female
• Progressive Weakness, fainting attacks since few
  months.
• Had blood transfusion for severe anemia a month
  ago.
• Hypertensive on Methyldopa.
• WBC count 166,000, MCV 110, gt80 lymphs

3
Blood Film
High WBC
4
Blood Film
High WBC
5
Blood Film
Lymphoid cells Smear cells (Fragile)
6
Blood Film
Lymphoid cells Smear cells (Fragile)
7
Blood Film (CLL)
Lymphoid cells Smear cells (Fragile)
8
Pathology Notes

• Very high Lymphocyte counts.
• Smudge or smear cells are prominent.
• Usually B cells but CD5ve (Tcell Marker)
• Lymphnode Hepatosplenomegaly usual.
• Anemia, thrombocytopenia usually seen in late
  stage.
• May develop autoimmune hemolytic anemia
• Infections common Immunodeficiency.

9
Bone Marrow Biopsy

• Highly cellular marrow

10
Bone Marrow Biopsy

• Highly cellular marrow

11
Bone Marrow Biopsy

• Predominantly mature Lymphoid cells

12
Bone Marrow Biopsy

• Predominantly mature Lymphoid cells (condensed
  chromatin)
• Scanty rim of cytoplasm.

13
Bone Marrow Biopsy

• Predominantly mature Lymphoid cells (condensed
  chromatin)
• Scanty rim of cytoplasm.

14
Bone Marrow Biopsy

• Few Immature forms