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№ 15Hematology15 min read

Chronic lymphocytic leukemia

1. Big picture

Chronic lymphocytic leukemia (CLL) is the classic leukemia of elderly patients: slow, indolent, often discovered incidentally on complete blood count (CBC) as persistent lymphocytosis. The oral exam pattern is:

Older patient + lymphocytosis + small mature lymphocytes + smudge/Gumprecht shadows + painless lymphadenopathy ± splenomegaly + low immunoglobulins → think CLL.

The examiner mainly wants you to know:

  1. Diagnosis is usually from peripheral blood flow cytometry, not bone marrow biopsy.
  2. CLL cells are mature-looking but functionally abnormal B cells.
  3. Do not treat early asymptomatic CLL — use watch and wait.
  4. Treat only if there is **a

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