Autoimmune complications in chronic lymphocytic leukemia: a single center experience

Chronic lymphocytic leukemia [CLL] is characterized by the progressive accumulation of B cells with mature appearance and a distinctive immunophenotype in peripheral blood, bone marrow, lymph nodes and other lymphoid tissues. Autoimmune complications are common in CLL and by far the most common manifestation is autoimmune hemolytic anemia [AIHA], followed by immune thrombocytopenia [ITP] and pure red cell aplasia [PRCA]. The study was carried was carried out to see the spectrum of autoimmune complications in patients diagnosed with CLL. This cross sectional study was carried out to describe the clinical presentation, haematological parameters and complications of CLL in patients coming to Shaikh Zayed Hospital [SZH], Lahore over a period of 6 years from June 2002 to July 2008. CLL cases were diagnosed according to the National Cancer Institute [NCI] criteria. The collected data was entered into SPSS version 13 for analysis. Thirty one patients were diagnosed with CLL and in 6 [19.4%] patients the disease was complicated by AIHA and in 1 [3.2%] patient by ITP at presentation. Autoimmune cytopenias were observed in 22% of 31 patients. Autoimmune hemolytic anaemia was more common than ITP, no patients of PRCA were recognized

Primary bone lymphoma mimicking as polyarthritis

A 17 years old boy presented with warm, tender and swollen joints of both upper and lower limbs along with inflammatory back pain and heel pain since 7 months. He had developed continuous high grade fever 3 days ago and complained of marked weight loss during the last 6 months. On examination his liver, spleen and cervical lymph nodes were palpable. X ray of the affected joints revealed osteolytic lesions in tibia, fibula, and humerus and fracture head of femur. Bone marrow examination revealed infiltration by sheets of lymphoid cells which were positive for leukocyte common antigen and CD[20]. The bone biopsy from a lytic lesion in proximal left tibia revealed a similar picture of infiltration with sheets of CD[20] positive lymphoid cells. Need to remember that lymphoproliferative disorders can mimic rheumatological disorders in clinical practice. The case is presented to share the experience of others

Acute lupus haemophagocytic syndrome

A 25 year old female who had been on treatment for Systemic Lupus Erythematosus for the last 12 years presented with high grade non-remitting fever and pleural effusion. She had delivered a full term baby girl and soon developed pancytopenia, markedly raised fibrinogen degradation products, deranged coagulation profile, low serum fibrinogen level, raised liver enzymes and grossly raised serum ferritin. Bone marrow examination revealed reactive haemophagocytosis and megaloblastosis. Autoimmune disorders can lead to reactive haemophagocytic syndrome which is a treatable entity even if it presents with life threatening complications

Frequency and pattern of bone marrow infiltration in Hodgkin's lymphoma

Lymphomas are malignant neoplasms arising from lymphoid tissue. They are divided into two groups i.e Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma. Staging of Hodgkin's Lymphoma is important for the management and treatment of the patient. This study was carried out to determine the frequency of bone marrow infiltration at the time of diagnosis as well as various patterns of bone marrow involvement. Clinical history and physical findings were recorded in the proforma. Investigations were carried out. Bone marrow aspirate and trephine biopsies were performed from posterior iliac crest. Aspirates and trephine biopsies were evaluated and assessed for cytology, marrow architecture, haemopoietic tissue and any lymphomatous infiltration. In cases with infiltration, the infiltration pattern was studied. Fifty Hodgkin's lymphoma patients were studied. Bone marrow infiltration was found in 19 [38%] cases. Among these 19 patients with infiltration 17 [89.4%] patients were of Hodgkin's Lymphoma mixed cellularity and 2 [10.5%] had Hodgkin's Lymphoma Nodular Sclerosis. Pattern of infiltrate was interstitial in majority of cases followed by diffuse type of infiltration. Bone marrow involvement in Hodgkin's Lymphoma is more common in our setup as patients present at a later stage. It is recommended that bone marrow examination should be performed as a part of staging investigations in patients with Hodgkin's Lymphoma