#00063008

A 69 years old male with marked Leukocytosis (200*10^9/L); anaemia (Hb=8g/dl) and Thrombocytopenia (plt=50*10^9/L).
Blood Film shows: Marked leucocytosis, Blasts comprised the majority (approximately 85%) of circulating peripheral blood. The blasts are large with high N:C ratio and prominent nucleoli and has fine chromatin, some blasts show fish mouth nucleus ("cup-like"). Auer rods not seen.
Based on clinical presentations, CBC result, and morphology, this case is highly suggestive of acute myeloid leukemia (acute myeloid leukemia with recurrent genetic abnormalities, mainly NPM1 and FLT3  mutation ) and further tests are suggested.

Acute leukemias with dual FLT3 and NPM1 mutations often present with high counts with frequent cup-like nuclear invaginations in the blasts.