Case history
Case history #1
A 65-year-old man presents with early satiety, fatigue, abdominal pain, and weight loss of 3 months' duration. He also notes easy bruising. Prior history is significant for mild anemia. On exam he has splenomegaly, with normal vital signs and no fever. There are palpable lymph nodes in the inguinal region and tenderness over the sternum.
Case history #2
A 35-year-old woman presents with a 2-month history of fatigue, lightheadedness, and visual scotoma. She denies paresthesia, weakness, or difficulty in speaking. She notes spontaneous and trauma-induced bruises on the extremities and increased menstrual flow over the last 4 months. She has lost 9 kg over 2 months, which she attributes to voluntary dieting and to early satiety. Examination is notable for resolving ecchymoses on her legs. The spleen is palpable 2 cm below the costal margin. No lymphadenopathy is noted.
Other presentations
An atypical presentation of blast crisis is with features of hyperviscosity disorder. For example, a young male may present with priapism and 20% blast cells on peripheral blood smear and, on further testing, is confirmed to have the Philadelphia chromosome. Other features of hyperviscosity include tinnitus, stroke, confusion, and stupor.
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