A pt with an Hb of 6, WBC count of 2000, has a normal Different count except for having 6% blasts; platelets are reduced to 80,000; moderate splenomegaly is present; possible diagnosis is:

Answer is A (Leukemia) The presence of Pancytopenia and 6% blasts in peripheral blood is enough to suppo the diagnosis of aleukemic leukemia. Presence of splenomegaly eliminates aplastic anemia & ITP as the possibilities and hemolysis does not explain the low WBC and platelet count in the patient. Leukemia: Although leukemia usually presents with an elevated WBC count the presence of Pancytopenia and 6% blasts in peripheral blood is enough to suppo the diagnosis of aleukemic leukemia. Some patients with aleukemic leukemia present with pancytopenia without circulating blasts. The diagnosis of leukemia in such patients should however be ideally made only once, a marrow blast count is done and it comes out to be > 30%. Presence of splenomegaly eliminates aplastic anemia & ITP as the possibilities. - Splenomegaly & Lymphadenopathy are extremely uncommon in ITP & their presence should lead one to consider other possible diagnosis. - Splenomegaly is characteristically absent in aplastic anemia and if present the diagnosis of aplastic anemia should be seriously questioned. - Hemolvsis does not explain the low WBC platelet count in the patient.