1. Casual finding in the Laboratory of Chronic Myeloid Leukemia Falcones,K; Ortega,JJ; Ricart,E; Molina,R Hospital Virgen de los Lirios de Alcoy
INTRODUCTION:
The chronic myeloid leukemia (CML) is a chronic myeloproliferative syndrome of a clonal nature, originated in the stell cell, resulting in an excessive number of myeloid cells in all stages of maturation. Sometimes it is diagnosed incidentally.
CLINICAL CASE:
A 73-year-old man who, after control analysis, showed extreme leukocytosis (247x10E9/L) with myelia. On examination, the patient presented splenomegaly and reported asthenia of months of evolution. Among his antecedents has: high blood tension, dyslipidemia. The results of the routine laboratory report: leukocytes 247x10E9/L, platelets 399x10E9/L. Blood smear was performed, reporting Anisotrombia, leukocytosis within a severe range, neutrophilia, lymphocytosis, monocytosis, eosinophilia, basophilia and immature granulocytes >5.9%. Leukocyte formula: 4% blasts, 2% polymorphonuclear cells, 44% lymphomononuclear cells, 37% segmented andsegmented, 4% eosinophils, 5% basophils, 3% monocytes, 1% lymphocytes. The patient is cited to expand the study; and start treatment with hydroxycarbamide + allopurinol. In the differential diagnosis, other diseases that cause splenomegaly such as myeloproliferative disorders must be taken into account: polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis. The diagnosis is confirmed by analyzing a blood smear combined with a bone marrow (BM) analysis, cytogenetic and molecular tests.

2. Biopsy and aspiration results of (MO) compatible with CML (15%blasts), quantitative PCR bcr/abl (e13/e14-a2) positive (ratio 64%IS). After of these results, the hydroxycarbamide is suspended and treatment with imatinib is started.
DISCUSSION
The patient presents constitutional symptoms indicating a hypercatabolic state, with additional symptoms related to splenomegaly, this state is characteristic of the chronic phase of CML. Some asymptomatic patients have an incidental
leukocytosis, as in our case, that when performing additional molecular tests it is found that it corresponds to a CML.
CONCLUSION After two months of treatment, the patient showed a clear improvement in his leukocyte count with figures of 4.08x10E9/L (with normal formula) in the last laboratory report of December/2018.