Hampel et al evaluated patients with previously untreated chronic lymphocytic leukemia (CLL) who had abnormal liver function tests. The presence of CLL-associated liver dysfunction is associated with a worse overall survival. The authors are from the Mayo Clinic in Rochester, Phoenix and Jacksonville.
Patient selection: untreated CLL with abnormal liver function tests
Frequency: about 4% of patients at presentation. It may also appear over time.
Clinical features:
(1) presence of untreated CLL
(2) abnormal liver function tests
(3) exclusion of other causes of liver disease (viral hepatitis, drugs, autoimmune, etc)
Liver biopsy may show a dense infiltration of lymphocytes in the portal triads.
Associated findings:
(1) advanced Rai stage (III or IV)
(2) lower hemoglobin concentration
(3) lower platelet count
Once treated the differential diagnosis of liver dysfunction would include therapy-associated hepatitis.
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