Snapshot A 60-year-old man presents with fever, long-standing fatigue, and shortness of breath on exertion. He also complains of easy bruising and occasional bleeding from his gums. On physical exam, he has cervical lymphadenopathy and marked hepatosplenomegaly. Peripheral blood smear shows large blasts. Introduction Acute leukemia with pancytopenia Epidemiology login to view 1 more bullet Subtypes login to view 11 more bullets Risk factors login to view 4 more bullets Presentation Symptoms of pancytopenia (high WBC count but WBCs are dysfunctional) login to view 4 more bullets Physical exam login to view 3 more bullets Evaluation Peripheral blood smear login to view 1 more bullet Most accurate test = flow cytometry Bone marrow biopsy with cytogenetics login to view 2 more bullets CBC login to view 3 more bullets Differential Diagnosis ALL Myelodysplastic syndrome CML blast crisis Leukemoid reaction Treatment Initial treatment with chemotherapy login to view 2 more bullets Bone marrow transplant after remission login to view 1 more bullet All-trans-retinoic acid (ATRA) to those with M3 (APL) Prognosis, Prevention, and Complications Prognosis login to view 3 more bullets Complications login to view 4 more bullets