Clinical features and presentation

• Often asymptomatic; lymphocytosis (>5.0 x 109/L) on routine FBC.

• With more advanced disease: lymphadenopathy: painless, often symmetrical, splenomegaly (66%), hepatomegaly and ultimately BM failure due to infiltration causing anaemia, neutropenia and thrombocytopenia.

• Recurrent infection due to acquired hypogammaglobulinaemia: esp. Herpes zoster.

• Patients with advanced disease: weight loss, night sweats, general malaise.

• Autoimmune phenomena occur; DAT +ve in 10-20% cases, warm antibody AIHA in <50% these cases. Autoimmune thrombocytopenia in 1-2%.

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