This acute myeloid leukemia shows that peripheral blood alone can put you on the wrong track. In this patient, pancytopenia was present and dysplastic, degranulated basophils were seen. At first glance, the picture appears to be consistent with an MDS. However, 30% blasts are counted in the bone marrow, making this an AML (possibly arising from an MDS). In addition, the ASXL1 mutation was detected.