Abstract
Chronic lymphoid leukemia (CLL) is a malignant hematopoietic disorder, the most common of all adult leukemias with a distinctive immunophenotype. It is well established that CLL patients can have autoimmune complications, amongst them autoimmune hemolytic anemia as the most frequent. This study was carried out to determine the frequency of direct Coombs Test positivity in CLL patients and its possible correlation with Rai staging, hematological parameters and biochemical markers. This descriptive cross sectional study was carried at Liaquat National Hospital from January 2011 to June 2013. Sixty untreated patients with B- chronic lymphoid leukemia were enrolled. Complete blood count, direct Coombs test, serum urea, creatinine, uric acid and LDH levels were determined. Data were compiled and analyzed using SPSS version 21. Out of 60 patients, 42(70%) were males and 18(30%) were females. Mean age was 59±9.2 years. Male to female ratio was 2.1: 1. The frequency of direct antiglobulin test (DAT) positivity was found to be 23.3%. The monospecific IgG was positive in 11 patients (18.3%); C3d positivity was evident in 1 patient (1.6%) and 2 patients (3.3%) had dual IgG and C3d positivity. The mean hemoglobin was 10.8±2.4gm/ dl. Significantly low mean hemoglobin of 8.3±3.0 gm/dl was seen in Coombs positive patients compared with negative patients having a mean hemoglobin level of 11.7±1.6 gm/dl (P<0.001). DAT positivity also demonstrated a positive association with advanced Rai stage III disease (P<0.01). No associations were noted with age, gender and biochemical markers. Direct Coombs test positivity in CLL in our patients, unlike in Western studies, appears relatively high, indicating significant autoimmune hemolytic anemia and advanced Rai stage in our setting. DAT positivity can be considered as a surrogative marker for advanced clinical disease.
Highlights
Chronic lymphoid leukemia is the most common type of adult leukemia in the western countries with an incidence of about 5 cases per 100,000 residents annually (Rozman et al, 1995; Zwiebel et al, 1998; Xu et al, 2009)
Previous studies have shown that autoimmune hemolytic anemia (AIHA) is usually observed in advanced stages of the disease and that Chronic lymphoid leukemia (CLL) patients with AIHA belong to a poor prognostic group (De Rossi et al, 1988; Foon et al, 1990).Determination of patient outcome with advanced stage CLL on the basis of the origin of the cytopenias can be important because of prognostic and treatment considerations (Moreno et al, 2008)
Biochemical markers were detected by Hitachi 912 (Japan) by photometric assay, while Direct coombs test was performed by column agglutination Gel technique (Diamed)
Summary
Chronic lymphoid leukemia is the most common type of adult leukemia in the western countries with an incidence of about 5 cases per 100,000 residents annually (Rozman et al, 1995; Zwiebel et al, 1998; Xu et al, 2009). The disease is characterized by a clonal accumulation of mature apoptosis-resistant neoplastic cells with a distinctive immunophenotype (i.e. SmIgdim, CD5+, CD19+, CD20dim, CD23+) in peripheral blood, bone marrow, lymph nodes and other lymphoid tissues (Hodgson et al, 2011; Shahjahani et al, 2015). The most frequently occurring autoimmune complication in CLL is AIHA (Engelfriet et al, 1992) It occurs in 10% to 25% of patients during their disease course (Dearden et al, 2008). This study was carried out to determine the frequency of direct Coombs Test positivity in CLL patients and its possible correlation with Rai staging, hematological parameters and biochemical markers. Conclusions: Direct Coombs test positivity in CLL in our patients, unlike in Western studies, appears relatively high, indicating significant autoimmune hemolytic anemia and advanced Rai stage in our setting. DAT positivity can be considered as a surrogative marker for advanced clinical disease
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Asian Pacific journal of cancer prevention : APJCP
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
