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Peripheral smear from a 90-year-old female who presented to the hospital with confusion and shortness of breath and was found to have a significantly elevated white blood cell count to 140 K/UL, hemoglobin 9.1g/dL, and platelets 52 K/UL. Her differential showed 135 K/UL blasts with a slight elevation of neutrophils, eosinophils, and monocytes. Peripheral smear showed large blasts with scant cytoplasm, prominent nucleoli, increased vacuoles, and some monocytic differentiation of cells. Peripheral blood flow cytometry confirmed acute monocytic leukemia. The patient also had spontaneous tumor lysis syndrome, disseminated intravascular coagulation, hyperleukocytosis/hyperviscosity syndrome, and other complications.
