Intermittent

A 50 year old woman complains of intermittent low grade fever for 6 weeks, in association with fatigue, night sweats, loss of appetite and loss of weight.

Close questioning reveals progressive distention of her abdomen for the past 6 months. She is otherwise asymptomatic.

She has lived in the United States for her entire life, and has never traveled abroad.

Select Relevant Investigations
Complete Blood Count + Peripheral Smear

Performed

WBC: 140,000/mm3 (4,600-11,000)
Hb: 6.5 mg/dL (11-18)
MCV: 84.1 (75-95)
MCH: 24.7 (24-32)
Plt: 34,000/mm3 (150,000-450,000)

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.
Ultrasound Abdomen

Performed

The ultrasound scan confirms the presence of hepatosplenomegaly. No free fluid is present.
Bone marrow Aspiration & Biopsy

Performed

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

Performed

Both thin and thick smears are negative for malaria parasites

Select Relevant Management
Tyrosine Kinase Inhibitors
Busulfan
Bone Marrow Transplantation
Radiotherapy