Investigation and diagnosis

• FBC : high WBC (typically >100 x 109/L; commonly >200 x 109/L in T-PLL); anaemia and thrombocytopenia usually present.

• Differential shows >55% (often >90%) prolymphocytes.

• Morphology: large lymphoid cells, abundant cytoplasm (B-PLL mainly), prominent single central nucleolus.

• Bone marrow diffusely infiltrated.

• Immunophenotype: ffltoble p174.

• Cytogenetics—B-PLL: 14q+ in 60%; t(11;14)(q13;q32)in 20%; p53 gene abnormalities in 75%; T-PLL chromosome 14 abnormalities in >70%; +8 in 50%.

Blood film in PLL: cells are larger than those seen in CLL but have similar 'mature' nucleus.

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