A 53-year-old man presented with severe back pain, abdominal distention and weight loss for several days. He had a history of chronic lymphocytic leukemia/small lymphocytic lymphoma proven by peripheral blood examination and lymph node biopsy five years ago and was started with chemotherapy three years ago. On admission, the total leukocyte count was 18,000/μl with 77.6% lymphocytes, 15.3% neutrophils, and 6.6% monocytes. A further manual differential count confirmed moderate lymphocytosis with a predominant population of prolymphocytes (20%) and paraimmunoblasts (30%) (Fig. 29.1). His hematocrit was 37.8%, hemoglobin 13.5 g/dl, and platelet count 103,000/μl. Serum lactate dehydrogenase was 343 IU/l.


Chronic Lymphocytic Leukemia Total Leukocyte Count Serum Lactate Dehydrogenase Severe Back Pain Prolymphocytic Leukemia 
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