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45 years male with no known co-morbidity, persented to the ER with acute loss of consciousness. CT head on arrival demonstrated intracerbral hemorhage. The platelets count on arrival was 4k with hypofibrinogenemia, and riased D-dimers. Peripheral blood smear demonstrated "Leukocytosis with monotonous population of immature medium to large cells with twisted nuclei and granuular salmon colored cytoplasm, representing 85% of WBC in the peripheral smear, suggestive of lukemia phase of microgranular variant of APL". Interphase FISH results are consistent with 98% of peripheral blood cells showing PML-RARA [t(15;17)] fusion POSITIVE hybridization pattern (consistent with APL), and disomy (normal copy number) for the remaining 10 tested loci.