Chronic lymphatic leukaemia terminating as erythroleukaemia.

Case report A 67-year-old man presented in May 1978 with malaise and splenomegaly. Initial blood count showed haemoglobin 12-1 g/dl, total white cell count 25 7 x 10'/1 (polymorphs 5 %, lymphocytes 93 %, eosinophils 2 %), platelet count 98 x 10'/1. Bone marrow examination showed a 66% infiltration by mature lymphocytes. Haematopoiesis otherwise was morphologically normal. A diagnosis of chronic lymphatic leukaemia (Fig. 1) was made and chemotherapy started with chlorambucil 4 mg daily. Splenomegaly regressed on treatment and he remained on chlorambucil until April 1979 and recommenced therapy in October 1979. In March, 1980, he was admitted to hospital complaining of tiredness and dizziness associated with dyspnoea, and occasional night sweats. On examination he was anaemic and in congestive cardiac failure. There was no lymphadenopathy but hepatosplenomegaly (liver 5 cm, spleen 6 cm) was present. Haematological findings included Hb 3.9 g/dl, total white count 2-0 x 109/1 (6% polymorphs, 90% lymphocytes, 4% monocytes, occasional nucleated red cell), platelet count 15 x 109/l, reticulocytes 1 %. Bone marrow aspiration showed erythroid hyperplasia and gross dysplasia and multi-nucleate forms (Fig. 2). Myeloblasts comprised 6% of nucleated cells. Normal haematopoiesis was markedly reduced.