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A 83-year-old female presents for evaluation of fatigue. Physical examination reveals no hepatosplenomegaly or lymphadenopathy. Laboratory workup shows leukocyte count 187.000/ JLL. hemoglobin 7. 3 g/dl. and platelet count 1 LJ .0001 JLL. Flow cytometry reveals an increased number of cells expressing CD13 and CD33. Approximately 10% to 15% of leukocytes stained positive for myeloperoxidase (MPO). Peripheral smear is shown below.
What is the most likely diagnosis?
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia with minimal differentiation
- Acute myeloid leukemia without maturation
- Chronic myelomonocytic leukemia (CMML)
- Chronic myeloid leukemia (CML)
Medicine
C. Peripheral smear shows the presence of blasts which appear to bear features of both myeloid and lymphoid lineages. Flow cytometry results support the diagnosis of AML, given the expression of myeloid markers. MPO stain is positive, which also helps confirm the myeloid lineage of these blasts. Flow cytometry and MPO staining serve as quick gross diagnostic tools to differentiate AML from ALL. Positivity for MPO in at least 3% of leukocytes diagnoses AML without maturation, as cases of AML with minimal differentiation stain negative for MPO.
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