Diagnostic Dilemma Between Chronic Lymphocytic Leukemia and non-Hodgkin Lymphoma: Best way forward?

A-55-year old female has presented to our hospital with a generalized lymphadenopathy and her complete blood count showing very low WBC count (2100 cells/microL) and her differential count of lymphocytes count is showing 45% and neutrophil count is 50% and hemoglobin is 5.9 gm%, MCV 90.1, MCH 27.8, MCHC 9.9. Previously, the patient had a differential count for lymphocyte 56% with the around same low Total WBC count. We are suspicious of the case might of CLL or NHL.

We have tried to know the absolute lymphocyte count (ALC) in an attempt to see if the first criteria in diagnosing CLL (Absolute B lymphocyte count in the peripheral blood ≥5000/microL [5 x 109/L], with a preponderant population of morphologically mature-appearing small lymphocytes.) is met.

Even though the total number of WBC is less than the 5000, we tried to calculate ALC with the following formula:

ALC (cells/microL) = WBC (cells/microL) x percent lymphocytes ÷ 100
= 2100*45/100
= 945 cells/microL

The point of contention is the diagnostic dilemma between CLL and NHL and the best way forward

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