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Part III • White Cell Disorders weight loss, low-grade fever, normocytic, normochro-mic anemia, night sweats, and splenomegaly. The chronic phase can last for months to years. CML is characterized by a chronic phase, an accelerated phase, and a blast phase. As the disease progresses, the features n, worsen. I

The accelerated phase has a rising peripheral | blood count, appearance of peripheral blasts and f promyelocytes, increase in splenomegaly, bone pain, | ^ thrombocytopenia, and a worsening anemia. j |

The acute phase or blast crisis is similar to an acute i | leukemia. Bone marrow and peripheral blood blasts * | counts are greater than 30%.1 Excessive bleeding, infec- | tion, petechiae, ecchymosis, and bruising are seen more f | in the later stage due to bone marrow failure.

Peripheral Blood and Bone Marrow

The peripheral blood smear shows the presence of a severe leukocytosis with the entire spectrum of the myeloid cell development. A mild normocytic, nor-mochromic anemia with nucleated red blood cells (nRBCs) is a common finding. Eosinophils and basophils also are increased in number. In the chronic phase, thrombocytosis is present. Figure 12.2 illustrates the spectrum of neutrophilic maturation seen in CML. As the disease progresses, the anemia worsens, and thrombocytopenia and younger and younger cells are

Figure 12.2

seen in CML.

Spectrum of neutrophil maturation

Figure 12.2

seen in CML.

Spectrum of neutrophil maturation seen. In the acute phase, the blast count increases and may be greater than 30%.

Examination of the bone marrow reveals a hyper-cellular marrow with marked myeloid hyperplasia. The myeloid-to-erythroid (M:E) ratio is 10:1 and can be as high as 25:1. A normal M:E ratio is 3:1. The bone marrow may become fibrotic as the disease progresses. Table 12.4 summarizes the peripheral blood and bone marrow findings in the three phases of CML.

Table 12.4 0

Peripheral Blood and Bone Marrow Findings in the Three Phases of CML

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