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EM@3AM: Pediatric Acute Lymphoblastic Leukemia

A 3-year-old male presents with pallor and nosebleeds. On exam, the patient looks pale and has petechiae across his arms and back. His spleen is palpable. Labs reveal white blood cell count 20,900/μL, absolute neutrophil count 10,400/μL, absolute lymphocyte count 1800/μL, hemoglobin 5.9 g/dL, and platelet count 20 × 10^3/μL. What's the diagnosis?