From Microcytic Anemia to Acute Lymphoblastic Leukaemia: A Case Report of Rapid Hematologic Transformation

This case study outlines the clinical progression of a 22-year-old male patient who initially reported symptoms of fever, severe fatigue and loss of appetite. Physical examination revealed mild splenomegaly accompanied by hematological abnormalities including moderate anemia and leukocytosis. General blood picture showed microcytic hypochromic red blood cells and neutrophilic leukocytosis with total leucocyte count of 16800/cu mm having 76% neutrophils, 22% lymphocytes, 1% eosinophils and 1% monocytes. Platelet count was within normal range and approximately 1.5 lac/cu mm. There was no significant past medical history or family history nor any history of smoking or alcohol abuse. Chest X-ray revealed only mild prominent broncho vascular marking. Patient was treated with antibiotics and came for follow up within a month with symptoms of fatigue and mild breathlessness on exertion. Examination revealed hepatosplenomegaly and on ultrasonogram hepatosplenomegaly with left sided gross pleural effusion and abdominal lymphadenopathy was revealed. On repeating a complete blood count, it showed marked leukocytosis with 90% lymphocytes. The peripheral blood smear examination revealed 80% lymphoblasts 10% neutrophils 8%lymphocytes and 2% eosinophils. This case shows the transformation of blood picture to acute lymphoblastic leukemia within a month's time in a 22 years old male.