Chronic Lymphocytic Leukaemia (CLL) is the most common form of adult leukaemia and occurs predominantly in patients over 55 years. It’s estimated that approximately 2,000 people in the UK will be diagnosed with CLL this year. Currently, there are approximately 20,000 people in the United Kingdom living with CLL.
The vast majority of CLL cases are a slowly progressive form of cancer involving mature white blood cell B-lymphocytes that tend to proliferate and live much longer than normal. These B-lymphocytes which are not fully developed and which do not work properly, accumulate in the blood, bone marrow, lymph nodes and spleen. This results in overcrowding of these areas and suppression of the formation and function of blood and immune cells. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further reduction in the body’s ability to fight infection.
Blood cells are normally produced in a controlled way, but in CLL the process gets out of control. The lymphocytes multiply too quickly and live too long, so there are too many of them circulating in the blood. These Leukaemia lymphocytes look normal, but are in fact not fully developed and do not work properly. Over a period of time the abnormal cells replace the normal white cells, red cells and platelets in the bone marrow.
Many cases of CLL are detected by routine blood tests in persons with no symptoms and these are said to be asymptomatic. This "smoldering" condition can continue for many years whilst others may experience more rapid onset of symptoms and a more aggressive form of the disease. Symptoms may include enlarged lymph nodes, enlarged spleen and liver, fatigue, bone pain, abnormal bruising, excessive sweating, loss of appetite, weight loss, re-occurring infections and lack of energy.
Complications can arise in CLL for a number of reasons with the malfunctioning immune system being the most common. An immune system which is operating below specification can result in persistent bacteria, fungi and viral infections. On the other hand an overactive immune system can result in the body destroying key cell lines such as red cells and platelets).
Another problem that can occur is that the bone marrow can become so ove crowded with CLL cells that its function becomes impaired. This results in the reduced production of red cells, platelets and normal white blood cells.
Bone Marrow Biopsy Films - Aspiration
Below are 2 actual images of a Bone Marrow Biopsy via a technique of Aspiration. Aspiration means the doctor sucks some bone marrow cells up into a syringe. The vast majority of cells in these slides are small lymphocytes. These are the small round navy blue cells in the left hand slide. You can of course see the red cells, which are orange. Neutrophils are the pinky cells with dark nuclei in the shape of a bar bell and eosinophils are those with bright red cytoplasm. There is one blast present, a larger round cell with a purple nucleus with a single small round paler nucleolus. In addition the right hand slide has a couple of myelocytes with eccentric nuclei, more cytoplasm and fine granules in it. Click the image to enlarge.
Bone Marrow Biopsy Films - Trephine
Below are 2 actual images of a Bone Marrow Biopsy via a technique called Trephine. Trephine means that the doctor removes a 1 or 2cm core of bone marrow in one piece. The left hand slide is a low power view of a bone marrow trephine, which just shows heavy infiltration with small round cells, and the right hand slide is a higher power view of the same. Click the image to enlarge.