CLL is characterized by?

ANSWER: (D) All the aboveREF: Harrison's 17th ed p. 693, Wintrobes 9th ed. 1976CLL is disorder of older patients with 90% of cases occurring after the age of 50 years and median age is 65 yrs.Found incidentallyHallmark is absolute lymphocytosisMost are found to have an isolated peripheral blood lymphocytosis during a routine blood test. Alternatively, lymphadenopathy, splenomegaly, or both may be detected during a regular physical examination. When symptomatic, the most frequent complaint is fatigue or a vague sense of being unwell. Less frequently, enlarged nodes or the development of an infection is the initial complaint, and the most frequent infections are bacterial pneumonias. In contrast to lymphomas, fever and weight loss are uncommon.Peripheral BloodThe diagnosis is now made with a count of greater than 5 x 10 VIPresence of typical immunophenotypic markers.The median lymphocyte count at diagnosis is 30 x lOVL.In most patients, the leukemia cells have the morphologic appearance of normal small to medium-sized lymphocytes with clumped chromatin, inconspicuous nucleoli, and a small ring of cytoplasm. Cytoplasmic inclusions occasionally may be observed in CLL cells and may be crystalline, globular, tubular, or rod-shapedRuptured lymphocytes ("basket" or "smudge" cells) are commonly seen in the blood smear, and the number of these cells increases with the lymphocyte count.