Image Based Question-65470

A 70 year old male patient presented with history of generalized weakness and lethargy for last 2 years along with occasional episodes of epistaxis. He has moderate splenomegaly. His complete Hemogram suggestive of Hb- 8.5 gm, TLC- 75000, DLC- 75% lymphocytes. Peripheral blood film Examination shows following picture. What is the most lilkey diagnosis?

A. PNH

B. CML

C. CLL

D. None of the above.

Correct Answer » C Explanation

Ans:C.)CLL.

PBF in patients of CLL shows characteristic Smudge cells as seen in above picture.

Chronic lymphocytic leukemia

• Chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) is a monoclonal disorder characterized by a progressive accumulation of functionally incompetent lymphocytes.
• CLL is the most common form of leukemia found in adults in Western countries.
• CLL is a disease that primarily affects the elderly.
• The incidence of CLL is higher in males than in females, with a male-to-female ratio of 1.7:1.
• Enlarged lymph nodes are the most common presenting symptom.Mucocutaneous bleeding and/or petechiae may be due to thrombocytopenia. Tiredness and fatigue may be present secondary to anemia
• Microscopic examination of the peripheral blood smear is indicated to confirm lymphocytosis. It usually shows the presence of smudge cells.
  • Smudge cells are the artifacts produced by the lymphocytes damaged during the slide preparation.