#00066486

A 64-year-old male with known comorbidities of type II diabetes mellitus and benign prostatic hyperplasia presented with a 7-day history of fever and easy fatigability. On examination, he was febrile and pale, with no petechiae or rashes; systemic examination was unremarkable. Laboratory evaluation revealed normocytic normochromic anemia (Hb 82 g/L), marked leukocytosis (WBC 183,000/µL) with 89% abnormal promyelocytes and 3% neutrophils, nucleated RBCs (2/100 WBC), and severe thrombocytopenia (<10,000/µL). Coagulation parameter (INR 1.09) and LDH (312 U/L) were noted. Peripheral smear examination revealed abnormal promyelocytes with apple core nucleus (Figures 1 & 2) and intense MPO cytochemical positivity (Figure 3), which raised suspicion of acute promyelocytic leukemia (APL). The patient was initiated on all-trans retinoic acid (ATRA), and subsequent molecular testing confirmed PML-RARA rearrangement.