Peripheral destruction of platelets in chronic lymphocytic leukemia: recognition, prognosis and therapeutic implications.

In patients with chronic lymphocytic leukemia and depressed platelet counts, it is important to discriminate between the thrombocytopenia due to bone marrow replacement with abnormal lymphocytes and that caused by increased peripheral destruction of platelets. The former is due to progressive chronic lymphocytic leukemia and, as a Rai Stage IV, carries a poor prognosis. The latter, as illustrated in four patients seen at the National Cancer Institute, may be remediable by either splenectomy alone or splenectomy followed by immunosuppressive and antitumor therapy. In all four patients, survival was substantially longer than for patients whose condition was classified as Rai Stage IV. The importance of identifying the subgroup of patients with chronic lymphocytic leukemia with reversible thrombocytopenia is emphasized by these examples.