Circulating Mature Megakaryocytes in an Unusual Case of BCR-ABL1-Positive CML

  • Saniya Sharma
  • Prashant SharmaEmail author
  • Man Updesh Singh Sachdeva
  • Jogeshwar Binota
  • Anil Sood
  • Pankaj Malhotra
  • Neelam Varma

Dear Sir,

A 64-year-old male presented with weakness for 6 months. Examination revealed moderate pallor with massive splenomegaly. Hemoglobin was 87 g/l, total leukocyte count (TLC) 15.0 × 10 9/l, and platelet count 787 × 10 9/l. Leukocyte differential showed 88% neutrophils, 08% lymphocytes, 02% monocytes, 01% myelocytes and 01% metamyelocytes with 1 nucleated red cell per 100 leukocytes. Basophils were nil even on a 500-cell differential count. Red cells were normocytic normochromic with a few dacryocytes and codocytes. Strikingly, several circulating megakaryocytes, mostly with segmented nuclei, along with a few bare megakaryocytic nuclei (Fig.  1) were noted in the tail of the blood film. Cytochemical leukocyte alkaline phosphatase (LAP) score was 92 (control 256).


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Conflict of interest

The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in this report involving a human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This is a purely observational report and no research procedure was done.

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Informed consent has been obtained for this manuscript.


  1. 1.
    Spiers AS, Bain BJ, Turner JE (1977) The peripheral blood in chronic granulocytic leukaemia. Study of 50 untreated Philadelphia-positive cases. Scand J Haematol 18:25–38CrossRefPubMedGoogle Scholar
  2. 2.
    Tahlan A, Varma N, Naseem S, Bansal D, Binota J, Sood A, Sachdeva MUS, Malhotra P, Varma S (2018) Comparative Study of clinico-hematological features, molecular spectrum and response to imatinib in chronic myelogenous leukemia patients: pediatric and adolescent versus adults. Indian J Hematol Blood Transfus 34:19–24CrossRefPubMedGoogle Scholar
  3. 3.
    Kamada N, Uchino H (1978) Chronologic sequence in appearance of clinical and laboratory findings characteristic of chronic myelocytic leukemia. Blood 51:843–850PubMedGoogle Scholar
  4. 4.
    Hansen M, Pedersen NT (1978) Circulating megakaryocytes in blood from the antecubital vein in healthy, adult humans. Scand J Haematol 20:371–376CrossRefPubMedGoogle Scholar
  5. 5.
    Murray NA, Roberts IA (1996) Circulating megakaryocytes and their progenitors in early thrombocytopenia in preterm neonates. Paediatr Res 40:112–119CrossRefGoogle Scholar
  6. 6.
    Hume R, West JT, Malmgren RA, Chu EA (1964) Quantitative observations of circulating megakaryocytes in the blood of patients with cancer. NEJM 270:111–117CrossRefPubMedGoogle Scholar
  7. 7.
    Anand M, Hazarika B, Kumar L, Kumar R, Chopra A (2016) High abundance of circulating megakaryocytic cells in chronic myeloid leukemia in Indian patients. Revisiting George Minot to re-interpret megakaryocytic maturation. Blood Cells Mol Dis 60:28–32CrossRefPubMedGoogle Scholar

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© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  1. 1.Department of HematologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Adult Clinical Hematology Unit, Department of Internal MedicinePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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