The patient in this case is a 60 year old woman, who presented with general malaise and sore bleeding gums. Their clinical history indicated recent complete remission for breast cancer, achieved after chemo- and radiotherapy.
The peripheral blood film showed approximately 80% blasts which were monoblastic in appearance, in addition to a moderate thrombocytopenia (60 x 10^9/L).
A bone marrow biopsy was performed, and showed a markedly hypercellular marrow with 90% blasts. Flow cytometry confirmed monoblastic phenotype (sorry, don’t have the full panel handy) and showed aberrant CD7 and CD56 which are markers of poor prognosis.
Given the past history of therapy with alkylating agents, this case falls into the district subtype of therapy related AML (t-AML).