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The marrow findings, in conjunction with clinical findings, raised a few differential diagnostic possibilities: primary myelofibrosis, acute megakaryoblastic leukemia, or acute panmyelosis with myelofibrosis.
Expression of erythroid specific genes in acute megakaryoblastic leukemia and transient myeloproliferative disorder in Down's syndrome.
(1,2) A rare form of childhood leukemia, acute megakaryoblastic leukemia, is approximately 500 times more common in children with DS than in healthy children.
The diagnostic criteria for acute megakaryoblastic leukemia associated with myeloproliferative disorders is the same as de novo disease.

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