A 31-year-old man presented to our department of internal medicine from Syria with weakness and weight loss in the last month accompanying night sweating; he also reported the appearance of diffuse pallor of the skin. He denied vomiting, shortness of breath, or any urinary symptoms. There was no history of peptic disease or any gastrointestinal bleeding. His past medical history was unremarkable with no chronic illness or medications. In Syria he has underwent some investigations for anemia without any results until now; in the last 2 months, he continued to receive blood units for symptomatic anemia despite the absence of clear diagnosis. On his admission, he was complaining of weakness, weight loss, and night sweats. His medical laboratory analysis showed a CBC with pancytopenia. On admission, the patient was afebrile; normotensive with normal cardiac rhythm, diffuse pallor was noted. The physical examination was otherwise normal. PR has no rectal bleeding or melena. There was no sign of purpura. Abdominal examination revealed hepatosplenomegaly, enlarged lymph nodes, without other findings. Complete blood count showed leukopenia (1400/μL) and thrombocytopenia (80,000/μL). The hemoglobin level initially was 9.0 g/dL (normocytic anemia MCV 81), RDW 18, lymphocytes 54%, and neutrophils 430. Blood chemistry showed normal level of sodium (135 meq/L) and potassium (3.8 meq/L). Serum creatinine was 0.7 mg/dL, BUN 12 mg/dL, and total bilirubin 0.4 mg/dL. AST was 11 IU/L, ALT 17 IU/L, GGT 21 IU/L, and Alk-Phos 79 IU/L, and a mild elevation of LDH was noted—370 IU/L. CRP was 136 mg/dL. No sign of hemolysis, direct coombs test was negative, and haptoglobin were normal. No schistocytes on blood smear. Fibrinogen was normal. Vitamin level as vitamin B12 was 128, folic acid was 3, ferritin was 2415, iron was 121, calcium was 8.9 mg/dL, phosphor was 5.1, and uric acid was 5 mg/dL. Peripheral blood smear showed bands 10%, lymphocytosis, and atypical lymphocytes. On abdominal ultrasonography, there was a mild hepatosplenomegaly. An abdominal and chest CT scan was done that revealed mediastinal and axillary lymphadenopathy and hepatosplenomegaly. The urine was normal. A bone marrow biopsy was performed and confirmed the diagnosis of acute myeloid leukemia and evidence of 90% blasts.