A middle-aged man has a white blood cell (WBC) count of 80 ´ 109/L with 90% lymphocytes and many smudge cells. Which of the following is most likely?

a. Chronic lymphocytic leukemia
b. Hairy cell leukemia
c. T-cell lymphoma
d. Sézary syndrome

ANS: A
Chronic lymphocytic leukemia is characterized by the accumulation of small lymphoid cells in the peripheral blood, with a lymphocytosis greater than10 ´ 109/L. Smudge cells, representing disintegrated lymphoid cells, are also present. They are of diagnostic significance.

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