Peripheral Blood

Patients with CML generally present with marked elevations of the WBC count. The mean WBC count varies between 200 and 250 X 109/L with a range of 25 to 750 X 109/L.32,65 If untreated, the WBC count tends to rise over the course of time; however, cyclic variations in the WBC count have also been reported.71 Such cycles are usually 50 to 70 days in length, probably reflecting a periodicity in granulocyte production.

In stable phase CML, the peripheral blood smear reflects all stages of granulocyte development, including early forms. However, myeloblasts and promyelocytes generally account for less than 10 percent of the cells. Eosinophils and basophils are usually present. The degree of basophilia is inversely related to prognosis and if the percentage of basophils in the peripheral differential exceeds 20 percent, a blast crisis is imminent72 (Plate 3-1G). A progressive increase in eosinophils may also be a poor prognostic sign, heralding the emergence of an accelerated course.73 Circulating normoblasts may be present. Throm-bocytosis (platelet count greater than 450 X 109/L) occurs in 50 percent of patients at presentation, with an additional 15 percent developing elevated platelet counts during the course of the disease.74 Levels greater than 1000 X 109/L are noted in about 25 percent of patients with CML.74 Thrombocytosis, probably reflective of an increased disease burden, is also inversely related to prognosis.75

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