MRCP2-2208

MRCP2-2208

A 55-year-old man presents with recurrent episodes of bleeding gums, nosebleeds and intermittent haematuria over the past 6 weeks. He has no significant medical history but is a heavy smoker of 25 pack years. He drinks alcohol occasionally.

During examination, scabs and dried blood are noted on mucous membranes. No arthritis or cutaneous abnormalities are observed. The nasal bridge appears normal. His conjunctiva is pale, and respiratory, abdominal and cardiovascular examination is unremarkable. The following blood tests are obtained:

– Hb 37 g/l
– MCV 87 fl
– Platelets 17 * 109/l
– WBC 44.0 * 109/l
– Blood film myeloblasts with elongated, needle-like cytoplasmic inclusions

– Na+ 147 mmol/l
– K+ 3.2 mmol/l
– Urea 7.8 mmol/l
– Creatinine 70 µmol/l

What is the most probable underlying diagnosis?