This photograph was made of the blood smear from a patient with CML in blast crisis. Note the extreme vacuolation of the blasts and of the promyelocytes. This is not, however, a finding for all cases of blast crisis.
About 80%-85% of all patients with CML develop blast crisis sometime in the course of the disease. Both clinical and laboratory changes indicate the development of a crisis. The laboratory changes may include one or more signs, such as a rise in the total white blood cell count, anemia, and thrombocytopenia. There may be an increase in the number of blasts and promyelocytes or an increase in the number of basophils and eosinophils. Megakaryocytes may appear in the blood. The blasts may become vacuolated, often considered a poor prognostic sign. There may be an increase in the number of monocytes. The NRBCs in the bone marrow may become bizarre with multiple nuclei and extremely condensed chromatin similar to the nuclei and chromatin in erythroleukemia. The laboratory findings for CML in blast crisis may resemble those for newly developed acute myelocytic leukemia (AML). In fact, CML may be considered a preleukemic phase of an acute leukemia.
Course Section: 08. Myelocytic Leukemia: Chronic and Acute
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