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A 6 6-year-old female previously heal thy presen ts for further evaluation of diffuse bone pai n. left-sided abdomi nal discomfort. and progressive fatigue for the last several mon ths. Examination is sign i ficant for splenomegaly, easily palpable below the left costal margin extending to the m idline. Laboratory evaluation reveals leukocyte count of 1 67.000/,LLL. hemoglobi n 9.2 g/dl. and platelet count of 730.000/JLL. Peripheral blood smear is shown.
What is the most likely diagnosis based on this clinical presentation?
- Chronic lymphocytic leukemia (CLL)
- Acute myeloid leukemia (AML)
- Chronic myeloid leukemia (CML)
- Acute lymphocytic leukemia (ALL)
- Hairy cell leukemia (HCL)
Medicine
C. The typical peripheral blood picture of chronic phase CML reveals evidence of left-shifted myeloid leukocytes with increased numbers of mature neutrophils, bands, myelocytes, and promyelocytes with little or no peripheral blasts. In addition, absolute basophilia is always present, usually with eosinophilia, as noted in the images. AML and ALL would be expected to exhibit in-creased number of myeloid or lymphoid blasts, respectively, in peripheral blood. CLL is characterized by increased numbers of mature lymphocytes in peripheral blood. HCL typically presents with pancy-topenia, and monocytopenia is very commonly seen and is a useful clue to the diagnosis.
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