PMC6786829_01
Peripheral smear.
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AST increased to 1,669, ALT to 518, total bilirubin to 19.8, along with acute renal failure, worsening coagulopathy and severe metabolic acidosis. A haematology consultant noted rare large blast cells on the peripheral smear (3 of 200 cells, Figure 1); peripheral blood flow cytometry did not detect these.
Microscopic examination of the liver.
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Microscopic examination of the liver and spleen found effacement of the normal architecture by a diffuse neoplastic infiltrate (Figure 2).
Microscopic examination of bone marrow.
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Bone marrow (Figure 3) was hypercellular (80%) with expansion by neoplastic cells.