Snapshot A 70-year-old Caucasian man sees his primary care physician for his annual physical and labs. He has no complaints, and his physical exam is normal. His only medical problems are hypertension, managed with medication, and hyperlipidemia, controlled with diet. A few days later, his physician is concerned, noting that his WBC count is 30,000/μL with 90% lymphocytes. Peripheral blood smear shows smudge cells. He calls the patient in for further testing. Introduction Clonal proliferation of incompetent B-cells Epidemiology login to view 3 more bullets Many are diagnosed incidentally with markedly elevated WBC Insidious onset of symptoms (chronic, not acute) Associated conditions login to view 1 more bullet Presentation Symptoms login to view 3 more bullets Physical exam login to view 3 more bullets Evaluation 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 4 more bullets Curative therapy login to view 1 more bullet Prognosis, Prevention, and Complications Prognosis login to view 2 more bullets Complications login to view 5 more bullets