Marked lymphocytosis suggesting chronic lymphocytic leukemia in three patients with hyposplenism

Three patients with hyposplenism of diverse cause are described, in whom marked persistent lymphocytosis suggested the diagnosis of an early phase of chronic lymphocytic leukemia. Absolute lymphocyte counts ranged from 4,900/mm3 to 10,500/mm3. Patient follow-up ranged from 120 months to 294 months. The clinical course and additional test results, including results of lymphocyte surface marker analysis in all three patients and bone marrow biopsy in two, excluded the diagnosis of chronic lymphocytic leukemia. The finding of marked lymphocytosis in the hyposplenic state is emphasized, extending the degree of absolute lymphocytosis previously reported and thereby expanding the differential diagnosis of sustained lymphocytosis. In addition, the normal findings on both bone marrow and surface marker studies, along with the prolonged clinical course, support the contention that this is a benign entity.