Diagnosis and investigations

• FBC and blood film show 4 WBC (generally >25 x 109/L, often 100-300 x 109/L): predominantly neutrophils and myelocytes; basophilia; sometimes eosinophilia.

• Anaemia common; platelets typically normal or 4.

• Neutrophil alkaline phosphatase (NAP) score and ESR 5 in absence of secondary infection.

• Bone marrow shows marked hypercellularity due to myeloid hyperplasia (blasts <10% in chronic phase; >10% in accelerated phase; >20% blasts + promyelocytes = blast crisis); trephine useful to assess marrow fibrosis.

• Cytogenetic examination of blood or marrow for confirmatory t(9;22).

Peripheral blood film in CML: note large numbers of granulocytic cells at all stages of differentiation.

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