Chronic lymphocytic leukemia, peripheral smear.
90% of CLL cases occur in patients over 50 years of age. Picture perfect autoimmune hemolytic anemia (schistocytes, spherocytes, DAT positivity) presents in 15-35% of cases. Patients tend to survive for a very long time (5-20 years), and unlike CML, there is no blast crisis and they usually die of some other infection.
Its main hallmark is absolute lymphocytosis, and the lymphocytes have very clumpy chromatin that makes them look like soccer balls (alternatively, they all just break and you get a slide full of smudge cells). It’s extremely easy to pick out once you’ve seen it since, by lymphocytosis, I mean I had a patient today with a white cell count of 549x10^9/L (high normal is 11x10^9/L for our region).
