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A 56-year-old Female with no significant medical history is admitted to the hospital with an acute left subdural hematoma after a Fall. Physical examination is significant For normal mental status. diffuse ecchymoses, and massive splenomegaly. Patient denies preceding abdominal pain. weight loss. Fevers. or night sweats. Laboratory evaluation shows leukocyte count of 119.000/pl. hemoglobin 8 g/dl. and platelet count 1 02,000/pl. Eosinophil and basophil counts are normal. Peripheral slide is shown below.
What is the most likely diagnosis based on the available clinical information?
- Chronic myeloid leukemia (CML)
- Acute myeloid leukemia (AML)
- Chronic myelomonocytic leukemia (CMML)
- Myelofibrosis (MF)
- Chronic lymphocytic leukemia (CLL)
Medicine
evidence oflymphocytosis as would be expected in CLL. Testing for BCR-ABL translocation is essen tial in distinguishing between CMML and CML, as CMML would be expected to test negative. CMML is classified as an overlap entity exhibiting features of both myelodysplastic and myeloproliferative syndromes in addition to a persistently elevated monocyte count in excess of 1,000/ j.iL. It presents with monocytosis in addition to anemia, thrombocytopenia, dysfunctional platelets, and splenomegaly (Leukemia. 2008;22(7):1308, Leuk Lymphoma. 2008;49(7):1292,] Neurosci Rural Pract. 2012;3(1):98, Br] Haematol. 2011;153(2):149).
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