Auer on the top!

摘要

A 34-year-old man presented with gum bleeding. His complete blood count revealed hemoglobin, 10 g/dL; red blood cells, 3.8 X 10~12/L; hematocrit, 34%; white blood cells, 64 X 109/L; and platelets, 12 X 10~-/L. The peripheral blood smear showed numerous blasts, small to medium in size with finely granular, basophilic cytoplasm and an occasional Auer rod; however, multiple Auer rods were noted on the top of the nucleus of a single blast (panels A-B). The chromatin pattern in the nuclei appeared to be dispersed with the presence of multiple nucleoli. A provisional diagnosis of acute promyelocytic leukemia (APL) was made on morphology alone with the clinician being immediately informed. Reverse transcription-polymerase chain reaction on the following day confirmed the presence of t(15;17)(q22;q12);PML-RARA consistent with APL.