Case 25 – update 4

In summary you have a gentleman in his 60s with previous splenectomy and high grade diffuse large B cell lymphoma treated with CHOP chemotherapy. He has presented with B symptoms and pancytopenia. He has some interesting travel history. From a haematology point of view you’re worried about secondary acute myeloid leukaemia/myelodysplastic syndrome or relapsed disease. He has hepatomegaly but it is thought a marrow biopsy is less risky than liver biopsy due to coagulopathy.

Here  is the marrow

image image

Questions

  • Has your differential changed?
  • How would you describe the appearances?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

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Online education and discussion about all things haematological
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