A 60 year old female presented with complaints of pain abdomen, breathlessness and easy fatigability since 2 weeks and swelling of both limbs since 1 week.
pulse 80 BPM
BP 170/90 mm of Hg
pallor+, BL pitting pedal edema+
PA- soft, massive splenomegaly+(22cms, crossing umbilicus)
RS- BL NVBS +, BL basal crepitus+
other systems were normal
Hb - 7.8 g%
total count - 2.12 lakhs/ cu mm
MPQBC was negative
platelet count -76000/cu mm
peripheral smear- microcytic hypochromic anemia
thrombocytopenia, 80% prolymphocytes, 6% neutrophils, 3% eosinophils
BM aspiration showed chronic lymphoproliferative disorder showing monotonous infiltration with small, round, mononuclear cells
positive to CD19, CD20, FMC7, KAPPA
negative to Txt, CD10, CD200, CD5
USG abdomen- BL grade 1 nephropathy, gross splenomegaly, ascitis
CXR - PA view BL lower zone consolidation
Dx- B cell prolymphocytic leukemia, anemia with thrombocytopenia.
Rx- pt was given packed cell transfusion and she is on chemotherapy with Fludarabine, Cyclophosphamide and Rituximab.