1. A Case Report
Ahmad Adel A.

2. A 57-year-old American woman presented to the emergency room with shortness of breath and chest pain.
The patient complained of fatigue, generalized body aches, and pain during the previous weeks.
She denied fever, chills, weight loss, or night sweats.
The patient had no significant medical history and was not taking any medications.
She had no family history of malignancy; she smoked 1 pack daily for many years and had a history of heavy alcohol use in the distant past, but denied any drug abuse.

3. The review of systems was negative for fever, chills, weight loss, night sweats, ecchymosis, or bleeding.
Physical examination revealed a pale-looking woman without any obvious distress.
She was afebrile with normal vitals. There were no petechiae or gum bleeding.
There was no history of melena, vomiting etc.
There was a palpable hepatosplenomegaly, and the rest of the physical examination was normal. She had a history of infusion of two units of blood 3 months back.

4. The patient’s initial complete blood count profile showed pancytopenia, white blood cell count of 3.3 * 103/µL, hemoglobin level of 4.4 g/dL, and platelet count of 29.0 * 103/µL.
Numerous nucleated red blood cells.
Examination of the initial bone marrow aspirate and biopsy revealed a markedly hypercellular bone marrow, essentially replaced by erythroid precursors, representing approximately 80–90% of the marrow cells.
The erythroid precursors displayed dysplastic morphology.
PAS is strongly positive, which is indicative of neoplastic erythroid precursors.

5. Morphology
The leukemic red cells are frequently bizarre with extreme dysplastic features including: giant forms, multinucleation, cytoplasmic vacuolization, and cytoplasmic buds.
Nuclei are round or irregular with lobulation and multinucleation.

7. criteria for diagnosis
Large, bizarre, round-to-oval cells.
> 80% Erythroblast.
MPO (+ve), PAS (+ve), Sudan black (+ve), Acid Phosphatase (+ve), and Non-specific esterase (-ve).

8. Diagnosis of the case: M6b

9. DEFINITION OF AML M6 5% of AML cases.
The current WHO classification subtypes it into two categories based on the presence or absence of significant myeloid component.
Erythroleukemia or Erythroid/Myeloid (FAB subtype A – M6a): comprises of >50% erythroblast and >30% myeloblasts.
Pure erythroid leukemia (FAB subtype B – M6b): comprises of >80% immature cells of erythroid lineage with no evidence of a significant myeloid component.