Master Chronic Lymphocytic Leukemia (CLL) with Picmonic for Physician Assistant

CLL is most commonly diagnosed in patients who are older than 60 years of age.

CLL is a neoplasm with overproduction of small, mature-appearing lymphocytes that can be seen in circulation on a blood smear. These cells will stain positive for CD5, CD20, and CD23.

The peripheral blood typically contains large numbers of small round lymphocytes with minimal cytoplasm. Some of these cells often come disrupted in the process of making smears and produce “smudge cells” that are characteristic of CLL.

Patients are often asymptomatic at diagnosis and when symptoms do appear, they are typically nonspecific and include easy fatigability and weight loss.

CLL is associated with cold agglutinin disease, which is an autoimmune disease characterized by the presence of high concentrations of circulating antibodies, IgM, directed against red blood cells. This manifests as a form of autoimmune hemolytic anemia, specifically one in which antibodies only bind red blood cells at low body temperatures, typically 28-31°C. This is particularly common in individuals greater than 50 years old.

CLL is commonly associated with warm autoimmune hemolytic anemia, which is often caused by the attachment of IgG antibodies to red blood cells.

Richter's transformation is seen when a patient with pre-existing CLL develops a new large-cell lymphoma, thought to be a progression of their underlying disease. It should be suspected when a CLL patient develops new lymphadenopathy, new systemic symptoms, or increasing levels of lactate dehydrogenase on labs. A biopsy should be done on the new lesions and will typically show diffuse large B cell lymphoma.