Clinical case: Elderly with lymphocytosis and asymptomatic – could it be cancer?

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JO is a 70-year-old man who is regularly followed up by his trusted nephrologist due to a diagnosis of systemic arterial hypertension, metabolic syndrome and chronic stage IIIa kidney disease (CKD) of probable hypertensive etiology. She has been using losartan, hydrochlorothiazide and amlodipine for over 20 years. He refuses to have knowledge of oncological or hematological diseases in the family. She denies other notable comorbidities or previous hospitalizations. It has a low geriatric fragility score and is completely independent of daily activities.

Three months ago, in a routine consultation, the patient had a blood count with leukocytosis of 13,000 at the expense of lymphocytes (absolute number of 5,110) and no other cytopenias. He denied other signs or symptoms at the time and it was only decided by monitoring the laboratory changes. Today he comes to a new routine appointment with a blood count showing leukocytosis of 25,000 / uL with lymphocytosis of 15,000 / uL in absolute numbers. She has mild normocytic and normochrome anemia with hemoglobin (Hb) of 11.2 g / dL and mild thrombocytopenia of 110,000 / uL. Lymphocytes with normal morphology in the peripheral blood layer, the presence of the famous “Gumprecht spots” (also known as mud cells) and the absence of explosions described in the hemogram.

On physical examination, you see no abdominal lymphadenopathy or organomegaly. The patient again reports having no symptoms. Which diagnostics is most likely? Is it a medical emergency?

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