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Chase the Case

Chase the Case #60 - Chronic Myeloid Leukemia -

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September 2026 (PDF for print)

Patient Demographics: Male, 56 years old

Clinical Presentation: Progressive fatigue for the past 4 months, unintentional weight loss of 8 kg over the past 3 months, night sweats, early satiety, abdominal fullness and discomfort in the left upper quadrant, mild pallor, significant splenomegaly (spleen palpable 8 cm below the left costal margin), and no significant lymphadenopathy.

Microscopy Review: Myeloblasts: 2%, promyelocytes: 6%, myelocytes: 18%, metamyelocytes: 14%, band neutrophils: 14%, segmented neutrophils: 38%, monocytes: 4%, eosinophils: 2%, basophils: 4%, nRBCs: 2/100 WBCs.

Additional Tests: LDH: 1,250 U/L, uric acid: 10.8 mg/dL, C-reactive protein: 1.2 mg/dL, positive Philadelphia chromosome t(9;22)(q34;q11), RT-PCR for BCR-ABL1: positive, BCR-ABL1 transcript: p210, International Scale (IS): 72%.

Diagnosis: Chronic Myeloid Leukemia (CML), Chronic Phase

Yumizen Clinical Insights: On the DIFF scattergram, an immature granulocytic population can be observed. This finding is also reflected in the extended WBC differential, with elevated IMG and IMM values within the LIC population, suggesting the need to investigate a hematologic malignancy. The analyzer alarms, together with the abnormal extended WBC parameters generated by the Yumizen H550, including elevated LIC, IMG, and IMM values as well as blast flags, support further evaluation for a hematologic malignancy. In addition, the presence of basophilia associated with immature WBC populations in the differential count is suggestive of chronic myeloid leukemia and should be interpreted in correlation with the clinical findings and confirmatory laboratory tests.

The blood smear showed left-shifted neutrophilia with all stages of granulocytic maturation present, ranging from blasts (2%) to mature neutrophils. Increased basophils were observed, and nucleated RBCs were also noted.

This clinical case has been provided by a laboratory in Brazil.

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