IMMUNOGLOBULIN GENE POLYMERASE CHAIN-REACTION TO DISTINGUISH HYPERREACTIVE MALARIAL SPLENOMEGALY FROM AFRICAN CHRONIC LYMPHOCYTIC-LEUKEMIA AND SPLENIC LYMPHOMA

Hyperreactive malarial splenomegaly (HMS) is found in geographical ass ociation with B cell lymphoproliferative disorders such as 'African' c hronic lymphocytic leukaemia (CLL) and splenic lymphoma with vilious l ymphocytes (SLVL). It is sometimes not easy to make a differential cli nical diagnosis between these conditions. We have previously used Sout hern blotting as a definitive method for the diagnosis of monoclonal l ymphoproliferation in these disorders, but this is expensive, lengthy and technically difficult. In the present paper we have compared South ern blotting with polymerase chain reaction (PCR) amplification of the immunoglobulin heavy chain gene. We found an excellent correlation be tween the 2 methods in demonstrating monoclonal populations of lymphoc ytes in patients with a clinical diagnosis of CLL or SLVL. We have fur ther demonstrated monoclonality in a patient who could not be classifi ed as CLL or SLVL on clinical criteria alone. In contrast, patients wi th well defined HMS or with non-B cell proliferations all showed polyc lonal rearrangements. We propose that the immunoglobulin gene PCR is a useful tool for the investigation of tropical splenomegaly of uncerta in origin.