Acute myeloid leukemia
D. Draw a complete blood cell count with differential to evaluate for leukemic retinopathy or blood dyscrasia
This patient had leukocytosis (white blood cells, 61 700/μL [to convert to cells × 109/L, multiply by 0.001]; normal limits, 4500-12 000/μL) with anemia (red blood cells, 2.71 × 106/μL [to convert to cell × 1012/L, multiply by 1.0]; normal limits, 3.9-5.5 × 106/μL; hemoglobin, 8.9 g/dL [to convert to g/L, multiply by 10.0]; normal limits, 14-18 g/dL; hematocrit, 26.8% [to convert to a proportion of 1.0, convert to 0.01]; normal limits, 40%-54%) and thrombocytopenia (platelet, 3.1 × 103/μL [to convert to cells × 109/L, multiply by 1.0]; normal limits, 150-400 × 103/μL). There were increases in the absolute number of neutrophils (7400/μL [to convert to cells × 109/L,multiply by 0.001]; normal limits, 17 800-53 600/μL), monocytes (18 040/μL [to convert to cells × 109/L, multiply by 0.001]; normal limits, 300-820/μL), basophils (620/μL [to convert to cells × 109/L, multiply by 0.001]; normal limits, 10-80/μL), and eosinophils (3700/μL [to convert to cells × 109/L, multiply by 0.001]; normal limits, 40-540/μL), with a normal lymphocyte count (2470/μL [to convert to × 109/L, multiply by 0.001]; normal limits, 1320-3570/μL). Peripheral blood smear showed 35% blasts, while bone marrow flow cytometry revealed 50% abnormal monocytes and 23% myeloblasts. All findings were consistent with a diagnosis of acute myeloid leukemia with monocytic features; cytogenetic analysis revealed an inversion on chromosome 16, which has been associated with favorable prognostic outcomes.1