Sudden onset of fatigue for the past few days

Question Number 1160
A 4 year old boy has the sudden onset of fatigue for the past few days. He begins experiencing bleeding of his gums and frequent bloody noses. He complains of bone and joint paint. His mother takes him to his pediatrician. On physical examination, he is pale and has numerous petechiae over his body. He is found to have lymphadenopathy and hepatosplenomegaly. Laboratory tests are done, including a CBC with differential. He has a white blood count of 100,000/ cu mm and numerous circulating blast cells. He is admitted to the hospital. On peripheral smear, no Auer rods are visualized. He is negative for Philadelphia chromosome. A bone marrow biopsy is done which shows 35% blast cells. Which of the following is most likely?
a) acute lymphoblastic leukemia
b) acute myelogenous leukemia
c) chronic lymphoblastic leukemia
d) chronic myelogenous leukemia
e) hairy cell leukemia

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