27 year-old white male with short history of fatigue and nose bleeding.

Here are the pictures from peripheral blood smear. WBC 57,000

This is a case of AML-M3v, microgranular variant. I wish I could post better microphotos. This is also a sad story. 

Patient was a 27 years old male with fatigue and nose bleeding. He went to a smaller hospital twice in a week for nose bleeding and was sent back to home with local treatment. Until he was lost consciousness with massive nose bleeding, he presented in our hospital. DIC with intracranial hemorrhage was diagnosed. We had the AML-M3 diagnosis in few hours. But it was too late. The patient passed away next day.

The clinical features and morphology were typical. Therefore, I will only explain more about the flow cytometry findings here. 

The leukemia cells are scattered high in monocytic area, because of low number/small granules in the cytoplasm (Fig. 1). In the CD45 and side scatter dot plot (Fig. 2), the cells are in low myeloid ares with same reason. Then, these cells are strongly positive for CD13, CD33, CD64, MPO and negative for HLA-DR. CD 34 is partially positive. In general, a leukemia with negative CD34, negative HLA-DR and positive MPO is diagnostic for AML-M3, less likely AML-M1.