What is the presentation and progression of persistent polyclonal B-cell lymphocytosis? — Kathy Burge, CFNP, Bluefield, W. Va.

Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare disease that is characterized by a stable, polyclonal CD19-positive and CD5-negative lymphocytosis. Middle-aged females who smoke represent the most common demographic group diagnosed with PPBL. 

Patients typically present with asthenia, myalgias, and splenomegaly. It is often mistaken for a low-grade lymphoma. The key to diagnosis is the presence of binucleated lymphocytes in the peripheral blood and a polyclonal increase in serum immunoglobulin M (IgM). 

Although PPBL is generally a benign disorder, about 10% of patients will go on to develop a malignancy, most likely diffuse large B-cell lymphoma. — Claire O’Connell, MPH, PA-C (190-3)


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