The peripheral smear reveals a normochromic normocytic anemia, and thrombocytopenia. Leukocytes are markedly increased, with 20% myeloblasts, 20% promyelocytes, 30% lymphocytes, 20% mature neutrophils, and 4% stab forms.
The ultrasound scan confirms the presence of hepatosplenomegaly. No free fluid is present.
Bone marrow Aspiration & Biopsy
Bone marrow studies reveal a hypercellular marrow. Erythroid series are normal, but megakaryocytes are reduced. Myeloid series are markedly increased with 45% myeloblasts, 30% promyelocytes,12% mature neutrophils, 2% lymphoblasts, and 2% stab forms. The myeloid:erythroid ratio is 9:1.
Flow cytometry reveals the presence of myeloid blasts. Cytogenetic studies of the marrow cells reveal reciprocal translocation of 22q to the lower arm of 9 and 9q.
Peripheral film for Malaria parasites
Both thin and thick smears are negative for malaria parasites