List clinical features.
About half of cases of CLL remain asymptomatic for a long period, resulting in late or incidental diagnosis.
Weight loss, fever, night sweats, fatigue (B symptoms)
Hepatomegaly and/or splenomegaly may occur.
Severe bacterial infections (e.g., necrotic erysipelas)
Viral infections (herpes zoster)
Symptoms of anemia and thrombocytopenia
What are the diagnostic criteria for CLL?
Persistent (≥ 3 months) lymphocytosis (≥ 5000 cells/mm3)
CLL immunophenotype confirmed by flow cytometry, including:
Expression of CD5, CD19, CD20, CD23
Light chain restriction (kappa or lambda)
List additional findings.
Additional findings: may further support the diagnosis
Anemia: may be caused by AIHA
Peripheral blood smear may show:
High percentage of small mature lymphocytes
Smudge cells (Gumprecht shadows): mature lymphocytes that rupture easily; appear as artifacts on a blood smear
Describe prognostic markers in CLL.
Prognostic markers in CLL
Indications for testing
Confirmed CLL diagnosis
FISH to assess for common structural chromosomal aberrations in CLL, e.g., del(17p)
Immunoglobulin heavy chain variable region (IGHV) mutational status
TP53 mutational status
Serum studies: β2-microglobulin and LDH
Adverse prognosis: e.g., del(17p) , del(11q), TP53 mutation, elevated β2-microglobulin, elevated LDH
Intermediate prognosis: trisomy 12 
Favorable prognosis: IGHV mutation , isolated del(13q)
Describe the bone marrow aspiration and biopsy.
Bone marrow aspiration and biopsy
Not routinely required for diagnosis
Consider in patients with cytopenias to determine the cause.
Typical findings in aspirate include a high percentage of small mature lymphocytes.
Acute lymphoblastic leukemia (ALL)
Autoimmune hemolytic anemia (AIHA)
Mantle cell lymphoma
Hairy cell lymphoma