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Atypical presentations in Chronic Myeloid Leukemia

Amar Ranjan Singh

Presence of megakaryocytes (MGK) in peripheral blood smear (PBS) is a rare condition. This may be seen in myelodysplastic syndrome. I am presenting a case of CML with lymphoid blast crisis showing MGK in PBS, probably first case report of this kind. smear showed a well formed large megakaryocyte.Bone marrow aspirate smear examination showed 80% blasts in diluted marrow. Bone marrow biopsy showed hypercellular marrow with near total replacement by blasts  CD34+ and CD3-, CD20- & CD138-Flowcytometry revealed  51% blasts positive for CD19, CD34, CD10, HLA-DR, dim positive for cCD79a & TdT and negative for CD45, CD20, CD38, CD33, CD13, CD117, CD64, CD3, CD4, CD5, CD7, CD8 & MPO. Diagnosis of ALL was given.On frequent routine haemogram, the value of platelet count was noticed always higher side (> 200 x 109/L). This raised suspicion of any other associated disease.