Chronic lymphocytic leukemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [3]

Overview

Laboratory findings consistent with the diagnosis of chronic lymphocytic leukemia include abnormal complete blood count, immunohistochemistry, and electrophoresis. Monoclonality of kappa and lambda producing B cells is a key diagnostic feature among patients with chronic lymphocytic leukemia.

Laboratory Findings

Complete Blood Count

• Absolute lymphocytosis ≥5000 B-lymphocytes/µL X ≥ 3 months
• Decreased hemoglobin concentration
• Decreased platelets count

Blood Smear

• Presence of smudge cells

Metabolic Panel

• Elevated low-density lipoprotein level

Quantitative Immunoglobulin Assay

• Quantitative measurement of IgA, IgG, and IgM immunoglobulins to detect hypogammaglobulinemia
• Elevated β2-microglobulin level

Electrophoresis

• Monoclonality of kappa and lambda producing B cells is a key diagnostic feature among patients with chronic lymphocytic leukemia.

Immunohistochemistry

• Chronic lymphocytic leukemia cells typically express CD19, CD20, CD23, and CD5 on the cell surface.

Peripheral Blood Cytogenetics

Peripheral blood cytogenetics and FISH determine prognosis in patients with CLL. The most important prognostic feature is the presence of absence of del(17p), which leads to the loss of TP53, a tumor suppressor gene. Presence of del(13q) is a favorable feature. Presence of del(11q) is an adverse prognostic feature.