Manohar, SJayakumar, N.2023-08-102023-08-102022-09Manohar S, Jayakumar N.. ”TAM”ing of the shrew-challenges in the diagnosis of Neonatal leukemia with Down's syndrome -A case report with literature review. Indian Journal of Pathology & Microbiology. 2022 Sept; 65(3): 699-7010377-49290974-5130http://imsear.searo.who.int/handle/123456789/223328The latest WHO (2017) classification describes the hematological abnormalities of Down's syndrome as a separate entity under 'Myeloid proliferations associated with Down's syndrome'. It includes Transient Abnormal Myelopoiesis and Myeloid leukemia of Down's syndrome. Here we report a case of a 3 days old neonate with Down's syndrome, presenting with a leukemic blood picture. The baby had icterus, fever and hepatosplenomagaly. Peripheral blood showed megakaryoblasts and giant platelets. A diagnosis of transient abnormal myelopoiesis was made by confirming with karyotyping and immunophenotyping. We attempt to address all the diagnostic challenges faced by a clinician and pathologist same, upon encountering such a case,by following an algorithmic approach. The mandatory need for follow up and cytogenetic studies in identifying high risk cases that will become myeloid leukemia of Down's syndrome are stressed. Our case also throws light upon the significance of identification of GATA1 mutation in diagnosing and prognostication of such cases.Acute megakaryoblastic leukemiaDownâ's syndromeGATA1newbornJournal ArticleIndiaDepartment of Pathology, Government Sivagangai Medical College, Sivagangai, Tamil Nadu, India