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Chronic Myeloid Leukemia (CML)


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.

Numerical Results

WBC 44.6 10e3/μL
NEU 40.47 90.59 %  IG/BAND
BLST .120 .269 %
MONe 2.09 4.69 %
EOS .215 .482 %
BASO .233 .522 %
LYM 1.526 3.419 % BLAST

RBC 3.63 10e6/μL
HGB 10.6 g/dL
HCT 33.3 %
MCV 91.7 fL
MCH 29.1  pg
MCHC 31.7 g/dL
RDW 12.5 %

PLT 71.3 10e3/μL
MPV 9.69 fL

CELL-DYN Ruby Casebook. Chronic Myeloid Leukemia (CML). 2018. ADD-00005070. p.42
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