Abstract
Objective:To determine the frequency of autoimmune cytopenias in chronic lymphocytic leukemia.Methods:This cross sectional study was carried out at Department of Hematology, Army Medical College Rawalpindi, in collaboration with Military Hospital Rawalpindi and Armed Forces institute of Pathology Rawalpindi from 1st January 2018 to 1st October 2018. Sample size of 64 was calculated using WHO calculator. Age and gender of patients was noted. Frequency of autoimmune hemolytic anaemia, immune thrombocytopenic purpura, pure red cell aplasia and autoimmune agranulocytosis were determined in diagnosed patients of chronic lymphocytic leukemia by various laboratory tests in our study population.Results:A total of 64 patients were included in the study, 53 (82.8%) were males and 11(17.2%) were females. Mean age of patients was 65 years. Autoimmune hemolytic anaemia was observed in 5/64 (7.8%) of patients. Immune thrombocytopenic purpura was seen in 2/64 (3.1%) patients. Autoimmune granuloytopenia and pure red cell aplasia were not seen in any patient.Conclusion:Autoimmune hemolytic anaemia and immune thrombocytopenic purpura are the most common causes of immune cytopenias in patients of CLL. Immune cytopenias should always be identified by laboratory tests as their management differs from other cytopenias which occur due to various other causes.
Highlights
Chronic lymphocytic leukemia is a significant sub group of chronic leukemias in adults.[1]
Chronic lymphocytic leukemia patients present with lymphadenopathy and peripheral blood lymphocytosis > 5 x I09/L which is characterized by CD 5+, CD19+ and CD23+ on immunophenotyping.[2]
Pathophysiological mechanisms involved in the development of autoimmune cytopenias in chronic lymphocytic leukemia include loss of self-tolerance and aberrant T- and B-cell function, resulting in auto antigen presentation by malignant CLL cells, antibody production by normal B cells and reduced immunity through loss of regulatory T-cells.[11]
Summary
Chronic lymphocytic leukemia is a significant sub group of chronic leukemias in adults.[1] Chronic lymphocytic leukemia patients present with lymphadenopathy and peripheral blood lymphocytosis > 5 x I09/L which is characterized by CD 5+, CD19+ and CD23+ on immunophenotyping.[2] These lymphocytes are morphologically mature but functionally incompetent. The disease has a peak incidence between 60 to 80 years of age. It is more prevalent in the western part of the world where it predominates in males.[3]. The risk of monoclonal B lymphocytosis changing to chronic lymphocytic leukemia is affected by polymorphism of genes controlling key functions in B cell development.[4]
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