Description

This patient had evident leukocytosis with a mild anemia and thrombocytopenia. In the SIZE/COMPLEXITY graph a notably disperse neutrophil cluster was seen, extending towards the upper central region of the plot. This corresponded to the presence of large-sized granular cells with characteristics (nuclear shape, nuclear/cytoplasmic ratio and granularity) that were different from normal mature neutrophils. These were immature granulocytes (myelocytes, metamyelocytes and non-segmented neutrophils). The suspected presence of immature precursors was indicated by the IG/Band flag. All four WBC scatterplots demonstrated large neutrophils, compatible with (meta) myelocytes that were seen in the smear. In the 90º/WBC 0º scatterplot there was a population of large mononuclear cells visible in the lower right corner (purple events). This population, classified as monocytes/blasts, corresponded well with the 4% blast counted by manual microscopy. Using molecular analysis, in this patient a diagnosis of chronic myeloid leukemia was made.