A 46-year-old male presents to the clinic with a complaint of fatigue that has gradually worsened over the past month. He reports occasional night sweats and weakness but denies significant weight loss or fever. His medical history is unremarkable, and he is not taking any medications. Physical examination reveals mild pallor and no significant lymphadenopathy or hepatosplenomegaly. The rest of the physical examination is unremarkable. Blood tests show pancytopenia, with a white blood cell count of 2.5 x 10^9/L (normal range: 4.0-11.0 x 10^9/L), haemoglobin level of 95 g/L (normal range: 135-175 g/L), and a platelet count of 60 x 10^9/L (normal range: 150-400 x 10^9/L). Peripheral blood smear reveals the presence of 10% blast cells.
Bone marrow examination shows hypercellularity with 70% blasts, many with abundant azurophilic granules and perinuclear hofs, along with the occasional Auer rod. Flow cytometry analysis of the bone marrow aspirate shows the blasts to express CD34, CD117, CD13, CD33, CD19 and CD56. What is the most likely diagnosis?Undifferentiated acute leukaemia Acute leukaemia with mutated NPM1 Acute megakaryoblastic leukaemia Acute myeloid leukaemia with t(8;21) Mixed phenotypic acute leukaemia
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