Cardiac tamponade as a symptom of the blast crisis of chronic myeloid leukemia

We report the clinical findings of a study on a 29-year-old woman diagnosed with chronic myeloid leukemia (CML) blast crisis with an initial presentation of cardiac tamponade. She first visited our hospital because of dyspnea experienced for 1 month. Other associated symptoms were abdominal fullness and bilateral lower leg pitting edema. She denied having any underlying disease. At the time of admission, her blood pressure was 82/50 mmHg and pulse rate was 120/min, with a marked paradoxical pulse. Initial laboratory findings revealed a white blood cell count of 614 10/mL, hemoglobin level of 4.6 g/dL, and platelet counts of 198,000/mL. The differential blood count showed 45% blasts, 10% promyelocytes, 4% myelocytes, 1% basophils, and 1% eosinophils, with normocytic normochromic erythrocytes (Figure 1B). Renal and liver functions were normal. An abdominal computed tomography scan revealed massive splenomegaly (Figure 1A), and bone marrow examination revealed hypercellularity, with a myeloid/ erythroid ratio of 13:1 and 65% blasts. Moreover, the Philadelphia chromosome was observed in all analyzed metaphases, and polymerase chain reaction revealed a bcr-abl rearrangement on P210 (b3a2). Flow cytometry revealed 96% CD33, 93% CD13, and an aberrant expression of CD7 and CD15. The diagnosis was Philadelphia-positive CML in blast crisis and a change in acute myeloid leukemia. Echocardiography showed a massive pericardial effusion with cardiac tamponade (Figure 1C). Furthermore, pericardial fluid cytology revealed leukemic cell infiltration (Figure 1D). No bacteria, fungi, or acid-fast bacilli were observed on repeated examinations. The patient was administered hydroxyurea, normal saline hydration (2500 mL/d), low-dose cytarabine (20 mg/m/d) for 5 days, and dasatinib (100 mg/d). Pericardiocentesis drainage was also performed, and initially 1200 mL of yellowish