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M4 Acute myelomonocytic leukemia (AMML) It is distinguished from M1, M2, and M3 by anincreased proportion of leukemia monocytic cells in the bone marrow or blood or both. Gingival hyperplasia with gingival bleeding is present. Serum and urine levelsof muramidase (lysozyme) are usually elevated because of the monocytic proliferation. The leukocyte count is usually increased monocytic cells (monoblast, promoncytes, monocytes), are increased to 5000/L or more. Anemia and thrombocytopenia are present in almost all cases. The marrow differs from M1, M2 and M3 in those monocytic cells exceed 20% of the nonerythroid nucleated cells. The sum of the myelocytic cells including myeloblasts, promyelocytes and later granulocytes is >20% and <80% of nonerythroid cells. This bone marrow picture together with a peripheral blood monocyte count of 5000/L or more is compatible with a diagnosis of M4.
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