Color Atlas of Hematology - Practical Microscopic and Clinical ...

76Abnormalities of the White Cell SeriesTable 8 Staging of CLL according to Rai (1975)StageIdentifying criteria/definition(Low risk) 0 Lymphocytosis 15 000/µlBone marrow infiltration 40%(Intermediaterisk)IIILymphocytosis and lymphadenopathyLymphocytosis and hepatomegaly and/or splenomegaly(with or without lymphadenopathy)(High risk) III Lymphocytosis and anemia (Hb 11.0 g/dl) (with orwithout lymphadenopathy and/or organomegaly)IV Lymphocytosis and thrombopenia ( 100 000/µl)(with or without anemia, lymphadenopathy, ororganomegaly)Table 9 Staging of CLL according to Binet (1981)StageABCIdentifying criteria/definitionHb 10.0 g/dl, normal thrombocyte count 3 regions with enlarged lymph nodesHb 10.0 g/dl, normal thrombocyte count 3 regions with enlarged lymph nodesHb 10.0 g/dl and/or thrombocyte count 100 000/µlindependent of the number of affected locationsCharacteristics of CLLAge of onset: Mature adulthoodClinical presentation: Gradual enlargement of all lymph nodes, usuallymoderately enlarged spleen, slow onset of anemia and increasingsusceptibility to infections, later thrombocytopeniaCBC: In all cases absolute lymphocytosis; in the course of the diseaseHb , thrombocytes , immunoglobulin Further diagnostics: Lymphocyte surface markers (see pp. 68 ff.); bonemarrow (always infiltrated); lymph node histology further clarifiesthe diagnosisDifferential diagnosis: (a) Related lymphomas: marker analysis,lymph node histology; (b) acute leukemia: cell surface marker analysis,cytochemistry, cytogenetics (pp. 88 ff.)Course, therapy: Individually varying, usually fairly indolent course;in advanced stages or fast progressing disease: moderate chemotherapy(cell surface marker, see Table 7)