A 67-year-old man presented with increasing weakness and shortness of breath for approximately two months. Physical examination revealed no lymphadenopathy or hepatosplenomegaly. His skin showed no petechiae or ecchymoses. Peripheral blood examination demonstrated a total leukocyte count of 16,900/μl with 18% segmented neutrophils, 4% bands, 47% lymphocytes, 1% monocytes, and 30% blasts (Fig. 23.1). The hemoglobin was 12.2 g/dl, hematocrit 39%, and platelets 21,000/μl. His blood chemistry panel was unremarkable except for a high level of lactate dehydrogenase (889 IU/l). A bone marrow biopsy was performed and showed almost complete replacement of the normal hematopoietic elements by blastic cells (Figs. 23.2 and 23.3).


Terminal Deoxynucleotidyl Transferase Burkitt Lymphoma Total Leukocyte Count Monocytic Leukemia Hematologic Neoplasm 
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