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Same as B with anemia (Hgb <11 g/dL for men and <10 g/dL for women) or thrombocytopenia (PLT <100,000/|L)

<2

Hgb, hemoglobin; PLT, platelets.

Hgb, hemoglobin; PLT, platelets.

Table 23.4 Evaluation of newly diagnosed patients with CLL

Essential studies History and physical examination CBC and differential

Morphologic examination of peripheral blood smear Immunophenotype of blood or bone marrow aspiration

Markers include surface Ig (IgM, IgD, and IgG), Ig light chains (k and X), CD5, CD19, CD20, CD23, CD79b, CD11c, CD22, CD38, CD10, and FMC7

Cytogenetic analysis with FISH for 13q deletion, 11q deletion, trisomy 12, and 17p deletion Serum chemistries including creatinine, p-2-microglobulin, quantitative Ig Serial CBC to determine lymphocyte doubling time

Optional studies

Bone marrow aspirate and core biopsy Leukemia cell ZAP-70 expression IgVH gene sequence provides prognostic information.3839 Quantitative immunoglobulin levels should be obtained to assess for hypogammaglobulinemia. Occasionally, IgG or IgM will be elevated, in which case serum protein electrophoresis with immunofixation can be obtained to evaluate for the presence of a monoclonal paraprotein.4041 If available, ZAP-70 expression should be measured as a prognostic marker. Further evaluation should be directed by clinical judgment. If AIHA is suspected, then reticulocyte count, direct and indirect Coomb test, haptoglobin level, lactate dehydrogenase, and fractionated bilirubin should be evaluated. Radiographic studies are not required for staging; however, they should be obtained when clinically indicated.

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