Coexistence of Monoclonal Gammopathy and Hemolysis in Chronic Lymphocytic Leukemia: Unveiling a Rare Case

In B-cell malignancies, there is a periodic presence of monoclonal gammopathies. In a notable multitude of cases with chronic lymphocytic leukemia (CLL), a cluster of antigen-inciting B-cells sometimes shows the presence of monoclonal gammopathy and autoimmune hemolysis simultaneously. The detection of monoclonal proteins or light chains in urine and/or serum is significantly increased in cases of CLL and can be identified using highly sensitive laboratory methods, such as serum protein electrophoresis. Hemolysis in these patients can be detected by the direct Coombs test (DCT). Several scientific research data indicate that the findings of hemolysis and the presence of monoclonal proteins have an adverse impact on the survival of patients. Nevertheless, there is no perspicuous proof to indicate the prognostic importance of hemolysis and monoclonal gammopathy in patients with CLL, even though monoclonal proteins and hemolysis in CLL generally occur at prevalences of 60%-80% and 5%-10%, respectively, very few cases have been reported in the literature. Owing to the peculiarity, we report a case of CLL diagnosed in 2023. The 66-year-old woman had developed the progressive disease along with the existence of monoclonal gammopathy and hemolysis. Although the manifestation of both findings could be due to the use of highly sensitive methods, it may also be attributable to an autoimmune process or progression from similar or distinct B-cell clones.