Richter's Transformation in CLL: Sysmex XN Scattergram

A clinical case of leukocytosis: an anomalous Sysmex XN WDF scattergram, suspicion of Richter's transformation in CLL, and lymphocyte morphology.

Anna Ivanova 1 min March 20, 2025

Sysmex analyzer screen: WDF scattergram with a characteristic anomalous "tail"

Analyzer screen: leukocyte distribution scattergram with a pathological pool

Sysmex analyzer screen: WPC scattergram with suspicion of lymphoma cells

Peripheral blood smear: pronounced lymphocytosis and Botkin-Gümprecht shadows

Peripheral blood smear: population of small mature lymphocytes in leukocytosis

Blood smear: atypical lymphoid cells of various sizes and disrupted forms

Blood smear: two large lymphoid elements with visible nucleoli

Blood smear: morphological comparison of an atypical cell (1) and a mature lymphocyte (2)

🔬 Case of the day: unusual WDF scattergram from Sysmex XN in an 82-year-old woman.

✅ Friends, I want to share an interesting case from practice. Blood analysis revealed an unusual “tailed” WDF scattergram, characteristic of blasts. However, microscopy showed atypical lymphocytes. The WPC channel indicates lymphoma cells.

Questions for discussion: Could this be Richter’s transformation in CLL? 🤔 What do you think, are there two cell populations observed here? What conclusion would you write on the CBC report? 🩸 Complete Blood Count: WBC: 122.44 (109/L) RBC: 4.04 (1012/L) HGB: 117 g/L HCT: 38.7% MCV: 95.8 fL MCH: 29.0 pg MCHC: 30.2 g/dL RDW-SD: 51.7 fL RDW-CV: 14.7% PLT: 165 (10*9/L)

🙏 Case kindly provided by clinical laboratory diagnostics physician, Anna Ivanova, Moscow