Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
A Case Report
A Dedication
About Our Fellows
About Ourselves
About Professor Js Bajaj
Abstract Article
Abstracts From Papers
Aero Medical Society
Aeromedical Assessment
Aeromedical Decision Making
Aeromedical Evaluation
Aircraft Accident Report
Aviation Physiology
Book Review
Book Reviews
Case Report
Case Reports
Case Series
Case Study
Civil Aerospace Medicine
Civil Aviation Medicine
Clinical Aerospace Medicine
Clinical Aviation Medicine
Clinical Information
Clinical Medicine
Clinical Series
Concept Paper
Contemporary Issue
Contemporary issues
Cumulative Index
Current Issue
Director General Armed Forces Medical Services
Exploring Space
Field Experience
Field Report
Field Study
Field Survey
Field Trials
Flight Trials
Guest Editorial
Guest Lecture
In Memoriam
Inaugural Address
Internet For The "Internaut"
Journal Scan
Know your President
Letter to Editor
Letter to the Editor
Letters to the Editor
Message From Our Patron
Methods in Aerospace Medicine
Methods in Medicine
News Of The Members
Notice To Contributors
Om Satya Mehra Award 1997
Orginal Article
Original Article
Original Article (Field Study)
Original Research
Our New President
Presidential Address
Questionnaire Study
Retrospective Study
Review Article
Short Article
Short Communication
Short Note
Society Calender
Society News
Teaching File
Teaching Series
Technical Communication
Technical Note
Technical Report
The Aviation Medicine Quiz
The Fellowship
Welcome Address
View/Download PDF

Translate this page into:

Case Report
45 (
); 14-15

Chronic lymphatic leukaemia in a civil aircrew : An unusual Presentation

Senior Adviser Medicine & Clinical Haematology, AFCME, New Delhi-110 010
Classified Specialist (Av Med) AFCME, New Delhi - 110 010
Classified Specialist ( Pathology & Neuro-pathology) AFCME, New Delhi-110 010
Air Officer Commanding, AFCME, New Delhi-110 010


Chronic Lymphatic Leukemia (CLL), a neoplasm of the activated B cell, is a rare form of leukemia in the Indian subcontinent. We document a case of CLL in a 56 year male, asymptomatic civil aircrew, with no abnormality on clinical evaluation who presented with marginal Ieucocytosis and lymphocytosis on routine blood counts. Lymphoid marker studies revealed dual expression of B cell antigens and T cell antigen on the cells, confirming the diagnosis of CLL and differentiating it from reactive lymphocytosis. The case reported comes under International Workshop on CLL staging classification A (O), which has a good prognosis, with a median survival of around 10 years. These patients require no treatment and need only regular follow up. The experienced Airline pilot has therefore been permitted to fly as pilot in command, along with another qualified and experienced pilot, with periodical reviews at AFCME.


Chronic lymphatic leukemia
Reactive lymphocytosis
B cell Antigens
T cell antigens

Chronic Lymphatic Leukemia (CLL) is a neoplasm of the activated B Cell. It is a relatively common form of chronic leukemia in the United States and the Western World, but is a rare form of leukemia in the Indian subcontinent. An unusual case of CLL in an asymptomatic civil aircrew with marginally elevated total white cell count, who came for medical evaluation to AFCME is reported, along with the relevant detailed workup to distinguish it from reactive lymphocytosis.

Case report

A 56 year male Airline Pilot with 13840 hours of flying experience and presently Captain on Boeing 747 - 400, reported to AFCME in June 2000 for medical evaluation. He had undergone TURP for Benign Prostatic Hypertrophy (BPH) at a civil hospital at Mumbai in April 2000. He was symptom free. On clinical evaluation there was no evidence of pallor, peripheral lymphadenopathy or hepat-osplenomegaly. Other systemic examination were normal. Blood counts revealed a Total Leucocyte Count (TLC) of 19,400/cmm with a Differential Leucocyte Count (DLC) of P 28 L 67 E04 M01. The peripheral smear was reported as reactive lymphocytosis. He was temporarily taken off flying duties for 04 weeks and advised for review with relevant investigations He reported for review in July 2000 with the investigation reports.


Hb: 14 gm/dl; TLC : 21,000/cmm ; DLC : P17 L 80 E 02 M 01 ; Platelets : 2.0 Lac/cmm ; Peripheral smear : Normocytic normochromic, No blast cells seen. Lymphocytes morphologically mature with occasional plasmacytoid cells present. Platelets adequate. Findings consistent with CLL; Lymphoid Markers : CD 5 (80% Positive), CD 19 (99% Positive), CD 20 (80% Positive) & CD 22 (43% Positive); Serum Uric acid : 4.8mg% ; LDH : 110 IU/L ; Other Biochemical parameters within normal limits ; lmmunofixation Electrophoresis ; No presence of any predominant light chains; Inaaaunoglobin Profile : Normal levels of Serum IgG. IgA & IgM; HIV & Hepatitis B : Negative ; HCV Antibody : Negative


CLL may be discovered as an incidental finding -complete blood counts. It is usually ■ patients over the age. of 50 years with a preponderance. The diagnosis in most cases e node on the basis of physical examination nien of peripheral blood smear, which shows a large number of morphologically normal, mature small lymphocytes. In cases with anemia, lymph node enlargement, splenomegaly or history of intercurrent infection the diagnosis becomes simple. The problem comes in differentiating early CLL from reactive lymhocytosis, in asymptomatic patients, as in the present case. In such cases lymphoid marker studies help, as the dual expression of B cell antigens (CS19, CD20, CD21 & CD24) with a T cell antigen (CD5) on the cells is diagnostic. The case reported comes under Rai stage A, or International Workshop on CLL staging classification A (O). Patients with early -stage CLL (stage A) have a good prognosis, with a median survival which exceeds 10 years. These patients require no treatment and need only regular follow up. The experienced airline pilot has therefore been permitted to fly as pilot in command, along with another qualified and experienced pilot. He will be reviewed periodically.


  1. , . The Leukaemias. In: , , , , , , eds. Harrison's Principles of Internal Medicine Vol II. (13,h International Edition). New York: McGraw Hill Inc; . p. :1771-1773.
    [Google Scholar]
  2. , . A clinical update on chronic lymphocytic leukaemia II Critical analysis of current chemotherapeutic modalities. Mayo Clin Proc. 1992;67:457.
    [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections