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Major takeaway

AML is defined as clonal expansion of malignant immature myeloid cells
A 68-year-old male comes to his provider’s office for evaluation of fatigue,
(>20%) in the bone marrow secondary to mutations. It usually presents with
weakness, and 8 kg (17.6 lb) unintentional weight loss over the past 2
anemia (fatigue, dyspnea), thrombocytopenia (easy bruising), and abnormal
months. Moreover, the patient reports feeling bloated after eating small
leukocyte function (infections). Peripheral smear shows myeloblasts with
quantities of food during this same time period. His past medical history is
nuclear atypia, fine azurophilic granules and Auer rods.  
notable for hypertension, and the patient is currently taking
hydrochlorothiazide. Physical exam reveals oral mucosal pallor. Cardiac and
Main explanation
pulmonary exams are non-contributory. Abdominal exam reveals
hepatosplenomegaly. Laboratory testing
This patient's clinical presentation results
(fatigue, are asinfollows:
dyspnea)  
combination with
 laboratory evidence of anemia, thrombocytopenia and leukocytosis, and
peripheral
 Laboratoryblood
value smear showing myeloblasts with Auer
 Result  rods, is consistent
with acute myeloid leukemia (AML).  
 Hemoglobin   9.5 g/dL 
 Hematocrit   28.5% 
AML is defined as clonal expansion of malignant immature myeloid
 Leukocytes  in the bone marrow. It usually 2,700/mm3 
cells (>20%) arises in older adults (average
 Platelets 
50-60  100,000/mm3 
years) and is mostly a result of acquired chromosomal abnormalities,
particularly translocations. These mutations cause proliferation of immature
myeloidofcells
Biopsy the in the marrow
bone bone marrow,
biopsywhich
showssuppresses
increased the growth
fibrosis andand
reduced cell
proliferation
count. of otherchain
Polymerase hematopoietic
reaction stem cells.
testing Risk factors
reveals for the in a gene
a mutation
development
encoding for aofnon-receptor
AML includetyrosine
radiation, chemotherapy (as
kinase. Which of theinfollowing
this patient),
diseases
tobacco
is smoking,
also caused Down
by an syndrome,
identical and myeloproliferative disorders.
mutation?

AML is divided into eight types (M0 through M7) based on cytogenetic
Elimination tool
abnormalities, cell lineage and surface markers. It commonly presents with
signs and symptoms of pancytopenia (fatigue, dyspnea, easy bruising and
A. Laboratory
infections). Fanconi anemia
analysis may show normochromic normocytic anemia,
thrombocytopenia and leukocytosis (due to circulating blasts). Peripheral
Show explanation ⌄
blood smear reveals myeloblasts with nuclear atypia and fine azurophilic
granules. Auer rods are pathognomonic of AML and appear as pink/red rod-
like granular structures in the cytoplasm, as shown with the arrow below.
B.diagnosis
Definitive Acute myeloid leukemia
requires bone marrow aspiration and
biopsy showing ≥20% blast cells.  
Show explanation ⌄

C. Follicular lymphoma

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