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Chronic Lymphocytic Leukemia (CLL)

Quick Review


Patient will be elderly (>65 y.o), have fatigue (due to anemia) and large firm mobile lymph nodes (supraclavicular, axillary and/or cervical lymph nodes). Splenomegaly on abdominal exam. Some patients may have B symptoms (night sweats, fever, etc). Some may have increased infections or weight loss. Some may be asymptomatic.

The key features are elderly patient with abnormal CBC and peripheral smear. CBC will show elevated WBC count, and on differential elevated lymphocytes. Peripheral smear will show increased lymphocytes (lymphocytosis) and they will be mature (small, little cytoplasm); smudge cells may also be seen. Flow cytometry confirms presence of clonal expansion of B lymphocytes by finding CD20, CD19, CD5 etc. Biopsy of the lymph nodes and bone marrow is not usually needed.


Key Features

  • most common leukemia in the USA
  • elderly "mature" patients
  • lymphocytosis (elevated WBC count due to lymphocytes, increased lymphocytes on smear)
  • lymphocytes are "mature" i.e. small size not blasts
  • smudge cells are pathognomonic for CLL


Relevant Images

Smudge cells

Lymphocytosis - increased number of mature lymphocytes on peripheral smear
Flow cytometry - learn about how this test works and is interpreted here. For CLL the result should be cells that are CD20, CD19, CD5 positive i.e. B-lymphocytes.
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