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Bone marrow biopsy from April 2020 and diagnosis of CML. A. The peripheral blood smear with granulocytosis, monocytosis, left-shift, and no obvious myeloid dysplasia. B. The aspirate smears also show myeloid hyperplasia and left-shift, no obvious erythroid dysplasia, and no increase in blasts. C and D. Bone marrow core biopsy with marked hypercellularity, myeloid hyperplasia, small hypolobated megakaryocytes, and no obvious increase in blasts.
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April 2020. A bone marrow biopsy showed markedly hypercellular marrow (100% cellularity) with granulocytic hyperplasia and atypical small hypolobated megakaryocytes (Fig. 1).
Bone marrow biopsy from February 2022 and diagnosis of CMML. A. Flow cytometry of the peripheral blood showing increased classic MO1 monocytes (99.48%). B. The aspirate smears show myeloid and monocytic hyperplasia but no obvious erythroid dysplasia or increase in blasts. C and D. The bone marrow core biopsy shows markedly hypercellular bone marrow with myeloid and monocytic hyperplasia, many small hypolobated megakaryocytes, and no obvious increase in blasts.
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Flow cytometry for the peripheral blood monocyte subset showed increased CD14+/CD16- classical monocytes (99.48%) (Fig. 2A). A repeat bone marrow biopsy in February 2022 showed hypercellular marrow (70%) with left-shifted myelomonocytic hyperplasia, occasional small hypolobated megakaryocytes, and no increase in blasts (Fig. 2B-D).