A 5-year-old girl presents with anemia, neutropenia, thrombocytopenia, lymphoblasts, and prolymphocytes. Cytochemical examination shows myeloperoxidase and SBB negative, and a positive for TdT. This hematologic picture is consistent with:

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The presence of lymphoblasts and prolymphocytes along with anemia, neutropenia, and thrombocytopenia indicate a diagnosis of acute lymphoblastic leukemia (ALL). The negative cytochemical staining for myeloperoxidase and Sudan black B (SBB) and the positive staining for terminal deoxynucleotidyl transferase (TdT) also support the diagnosis of ALL. AML would typically show positive staining for myeloperoxidase and/or SBB. CLL and CML would not present with lymphoblasts in the peripheral blood smear.

A 5-Year-Old Girl Presents with Anemia, Neutropenia, Thrombocytopenia, Lymphoblasts, and Prolymphocytes