Acute leukemia Quiz: Ace Your Exams

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A 65-year-old woman comes to the clinic because of shortness of breath and fatigue for the past 2 months. The patient states that she feels tired all day and has little energy to get out of bed. She also reports frequently stopping to catch her breath after climbing a flight of stairs. Past medical history is significant for breast cancer treated with chemoradiotherapy 10 years ago. Family history is noncontributory. Temperature is 37.0°C (98.6°F), pulse is 101/min, respirations are 20/min, and blood pressure is 135/85 mmHg. Physical examination shows mucosal pallor but no lymphadenopathy. Laboratory evaluation reveals:  
 
 Laboratory value  Result 
 Complete blood count 
 Hemoglobin   8.0 g/dL 
 Platelet count   70,000/mm3 
 Leukocyte count   16,100/mm3 

Peripheral blood smear is shown below:  
A microscopy image shows a blood smear with purple-stained cells. Several large, dark purple blast cells are scattered among numerous smaller, lighter red blood cells.
Reproduced from: Wikimedia Commons
Which of the following is the most likely diagnosis in this patient?

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