Clinical Case 14 - Richter syndrome

Patient demography: Female, 62 years old
Diagnosis: Chronic Lymphocytic Leukemia -> Possible transformation on 8/23/19 biopsy for Richter’s Syndrome.
Other information: Patient diagnosed with chronic lymphocytic leukemia since 2015, elective chemotherapy (venetoclax) with evolution to Tumor Lysis Syndrome, maintaining hyperkalemia, hypocalcemia, high uric acid, associated with general malaise, fatigue, nausea and vomiting (1 episode), diarrhea (4 episodes of yellowish liquid stools) and paresthesias.
Medicines: Elective chemotherapy (venetoclax), replacement of 4 ampoules of Calcium Chloride in total.
Other results: Ferritin 553, Iron 138, TF 1.85, ST 85, PTH 110, VIT D 23.3
Microscopic review: L ymphocytes 59%, Neutrophils 33%, Nucleolated basophilic large atypical lymphoid cells, ranging from lymphoplasmacytoid to immature immunoblast like forms, Thrombocytopenia confirmed on slide.
Analyzer: Yumizen H2500/H1500
Case provided by: Dr. Cristina Rosseto, Technical Manager, Botucatu Municipal Laboratory, Brazil