A 27 yrs old pt. driver by profession. His c/o multiple joints pain (mostly big joints) and mild swelling, abscess formation in diff. location in body (armpit,groin,thigh,back,etc.), mild fever, decreased wt, anorexia. O/E: pt.is pale, lethargic, BP - 100/60mmhg, P/H/O: ex-alcoholic. His Blood investigation reports: Hb - 3.6% Plt cont - 80,000 wbc - 39000 increase serum LDH level, increase vit.B12 level >2000 ESR - 140 Peripheral smear shows: Dimorphic anemia, (shift to left) atypical lymphocyte, immature granulocyte, hyper segmented neutrophils,leuko+lymphocytosis with 10% blast cell.
platelets large in size immature platelets fraction 23.8. Bone marrow shows giant metamyelocyte, megaloblastic with dyserythropoietic. Bone marrow trephine shows marked myeloid hyperplasia. Suggest d/d and management for this case.
