A 64-year-old man presented with a 4-week history of increasing fatigue and malaise. The patient had an episode of coughing up blood and bleeding from his gum. At the emergency department, he was found to have severe thrombocytopenia and received platelet transfusion immediately. On admission, the laboratory studies showed a total leukocyte count of 5,900/μl, hematocrit 32.5%, platelets 51,000/μl and lactate dehydrogenase 926 IU/dl. His coagulation studies, including prothrombin time (PT) and activated partial thromboplastin time (aPTT), were within normal limits. Physical examination showed petechiae in the palate and the lower extremities, but no hepatosplenomegaly and lymphadenopathy. Radiologic examination showed no lymphadenopathy in the abdomen and no mass in the ileocecal area. The peripheral blood smear revealed rare blasts (Fig. 55.1). Bone marrow aspirate demonstrated 80% blasts (Fig. 55.2). The core biopsy showed 90% cellularity with extensive blastic infiltration, replacing the normal hematopoietic cells (Fig. 55.3). There were many mitotic figures, but apoptosis was not prominent.


Acute Lymphoblastic Leukemia Bone Marrow Aspirate Burkitt Lymphoma Peripheral Blood Smear Severe Thrombocytopenia 
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