Chronic Lymphoid Leukemia Differential Diagnosis Table

Chronic Lymphoid Leukemia Differential Diagnosis Table:

Chronic lymphoid leukemia (CLL) is a type of cancer that develops in the bone marrow. It affects the cells that grow into lymphocytes (WBCs). It forms a type of malfunctioned lymphocytes in large numbers and lives longer than normal lymphocytes.
The term chronic in CLL refers to the slow growth of cancer; usually, patients have the disease for years before any symptoms appear. Symptoms of CLL are vague, like fatigue, dizziness, weakness, and weight loss, which make diagnosis harder. Most patients discover they have CLL during routine checkups.
Diagnosis of CLL is based initially on CBC and the number of white blood cells and lymphocytes. If they are elevated, doctors usually suspect lymphoma or leukemia. Biopsy and immunophenotyping can confirm diagnosis and differentiate between different types of leukemia.
The goal of treatment in CLL is to slow the prognosis of the disease, improve patient quality of life, prevent complications, and keep the patient in remission.

How To Distinguish Chronic Lymphoid Leukemia from Other Conditions

Distinguish Small Lymphocytic Lymphoma from Chronic Lymphoid Leukemia – Diagnosis

Small lymphocytic lymphoma (SLL) is a cancer that develops from B-cell lymphocytes. It’s a slow-growing tumor that usually doesn’t cause any symptoms. Most patients find out about the disease during routine check-ups.

• After initial investigation with CBC and WBCs, the main diagnostic test for confirmation of SLL is lymph node biopsy.
• Immunophenotyping is usually required after biopsy to detect the exact type of lymphoma.
• Imaging tests like CT scans, X-rays, and PET scans are needed to see if the tumor metastasizes to other organs.
• Flow cytometry is used to analyze cells; it helps detect any abnormalities in cell division or growth and can be useful in detecting early signs of relapse.

“Small lymphocytic lymphoma and chronic lymphoid leukemia are very similar even in symptoms; the only difference between them is that in SLL, cancerous cells develop from lymph nodes or spleen, while in CLL they develop from the bone marrow.”

Distinguish Hairy Cell Leukemia from Chronic Lymphoid Leukemia – Diagnosis

Hairy cell leukemia is a type of blood cancer that results in abnormal lymphocytes; they look hairy under the microscope. They grow faster than normal cells, but the disease itself grows slowly and sometimes it may not progress at all.

• Peripheral blood smear can be used to show the characteristic hairy cells under the microscope.
• Bone marrow aspiration and biopsy are needed for confirmation of diagnosis.
• Flow cytometry is used to detect any abnormalities in blood cells.
• Cytogenetic analysis can be used; it helps in detecting any chromosomal changes or damage.

Distinguish Infectious Mononucleosis from Chronic Lymphoid Leukemia – Diagnosis

Infectious mononucleosis, commonly known as mono, is an infectious disease caused by the Epstein-Barr virus (EBV). It’s very contagious and transmitted by saliva. Mono usually causes symptoms like fever, fatigue, swelling of lymph nodes, and leukocytosis. Treatment is usually only to manage symptoms.

• Initial diagnosis of mono is by clinical presentation and symptoms.
• Diagnosis of mono depends on the presence of heterophile antibody, using rapid Heterophile antibody test or monospot test.
• Serology testing for detection of EBV antibodies either IgG or IgM.

“Although mono is a very common viral infection, some complications like enlarged spleen or liver may occur, and even after resolution of symptoms, these complications may last.”

Distinguish Rheumatoid Arthritis from Chronic Lymphoid Leukemia – Diagnosis

Rheumatoid arthritis (RA) is an autoimmune disease causing inflammation in the lining of joints called synovium. This results in inflammation and pain in hands, feet, and ankles. During disease flare-ups, other parts of the body may be affected by the inflammatory response in the body. Current treatment in RA has helped in maintaining disease and improving quality of life.

• Blood tests to check for certain markers and antibodies such as Rheumatoid factor, although it’s 80% positive in rheumatoid patients, and Anti-CCP found positive in about 70% of patients.
• Imaging tests like X-rays can help in visualizing inflammation of joints and the extent of damage.
• Other blood tests like CRP and ESR can also be used, although they are not specific, but they can help in monitoring disease progression and response to treatment.

Distinguish Systemic Lupus Erythematosus from Chronic Lymphoid Leukemia – Diagnosis

Systemic lupus erythematosus is an autoimmune disorder that causes the body’s immune system to attack healthy tissue of connective tissue, causing damage to organs like lung and kidney. Medications can help in controlling disease flare-ups.

• Testing for ANA is used; it’s almost positive in most SLE patients but it may be present in other autoimmune diseases as well.
• Testing for anti-double-stranded DNA is also used; the higher the level of anti-dsDNA, the more active and aggressive the disease is.
• The anti-Smith antibody is almost only present in SLE patients, but not all patients have it.
• Other blood tests like CRP and ESR are routinely checked for monitoring disease flare-ups.
• Tests like urinalysis and renal function are needed to see if the disease caused any complications.

“Diagnosis of SLE is challenging, and there’s no specific test for diagnosis; a series of diagnostic tests plus patient clinical presentation and symptoms are needed.”

Distinguish Non-Hodgkin’s Lymphoma from Chronic Lymphoid Leukemia – Diagnosis

Non-Hodgkin’s lymphoma is a type of cancer that involves lymph nodes. It has many types that range in severity and vary in treatment as well. Symptoms are often mild, making early diagnosis hard; most patients go for examination once they feel a swollen lymph node.

• Lymph node biopsy is the main diagnostic tool for the disease; after confirmation, immunophenotyping is usually needed for specifying the exact type of lymphoma.
• A PET scan is also needed to give further information about where cancer metastasizes and progression of the disease; routine PET scans every 6 months are usually needed.

Distinguish Leukemoid Reaction from Chronic Lymphoid Leukemia – Diagnosis

Leukemoid reaction is the body’s response towards stress, trauma, or infection. It occurs as an increase in WBC count, more than 50,000 cells/μL, that may mimic malignancy or tumor.

• An increase in lymphocyte count with an increase in neutrophils may be indicative of the disease.
• Peripheral blood smear with the presence of neutrophil precursors.
• Bone marrow aspiration may be needed to rule out any malignancy or cancer.

Distinguish Reactive Lymphocytosis from Chronic Lymphoid Leukemia – Diagnosis

Reactive lymphocytosis is an immunological response against the body; it’s an increase in lymphocyte count, which means that the body is fighting an infection or a foreign body. Reactive lymphocytosis is not a specific sign for any disease; it is present in many underlying conditions ranging from severe series conditions to mild ones.

• Initial diagnosis and investigation for reactive lymphocytosis are based on the elevated number of lymphocytes in CBC.
• Peripheral blood smear is needed for further investigation of lymphocytosis; it can provide more information about the type of lymphocytes and stages of maturity, which can help in knowing the underlying condition.
• Blood cultures may be needed to know if there’s a source of infection.
• Rarely, a bone marrow aspiration is needed if other tests didn’t show any underlying condition to rule out the presence of malignancy.

Important Red Flags in Chronic Lymphoid Leukemia

Although chronic lymphoid leukemia is a type of cancer, the survival rate of the disease is very high, and some patients can live even without treatment.
Some red flag symptoms may be present that reflect the disease is getting worse and may need attention, like losing weight without trying, extreme fatigue, and night sweats. This can also indicate the presence of anemia.
Other important symptoms like the presence of continuous fever or recurrent infection. This may indicate that the immune system is very weak due to malignancy.
Presence of bleeding or bruising easily, although may reflect problems in bone marrow and its function.