Snapshot A 62-year-old Caucasian man complains of months of fatigue. He notices that his skin seems abnormally yellow. On physical exam, he has notable tender lymphadenopathy. Peripheral smear reveals some spherocytes and lymphocytosis. His leukocyte count is 35,000/μL with 95% lymphocytes and a Hb of 7 g/dL. His direct Coombs test is positive with anti-IgG. He is started on fludarabine. Introduction Clonal proliferation of incompetent B-cells login to view 4 more bullets Many are diagnosed incidentally with markedly elevated WBC Insidious onset of symptoms Epidemiology > 60 years of age Most common form of leukemia in adults in Western countries More common in Caucasian males ETIOLOGY Associated conditions login to view 1 more bullet Presentation Symptoms login to view 7 more bullets Physical exam login to view 2 more bullets STUDIES Labs – CBC login to view 3 more bullets ↓ IgG in half of patients Most accurate test login to view 1 more bullet Peripheral blood smear login to view 2 more bullets Differential Diagnosis AIHA Mantle cell lymphoma ALL Hairy cell lymphoma Treatment Treatment only for symptomatic or rapid progression login to view 2 more bullets Curative therapy login to view 1 more bullet Complications Richter syndrome/transformation login to view 4 more bullets Infections secondary to hypogammaglobulinemia Prognosis Most live 5-10 years after diagnosis Some die rapidly, within 2-3 years