A case of CML in a fifty seven year old female patient of special interest is reported.
At the onset her chief complaints were abdominal discomfort and fatigue. On physical examination, no splenomegaly was found.
Hematological examination could not reveal definite sign of CML except bone marrow smears; she showed normal leukocyte count with normal numbers of basophils and normal LAP score. Philadelphia chromosome was clearly identified in bone marrow cells.
Such conditions lasted about a year and a half then she suddenly showed leukoctyosis with basophilia and low LAP score, at the same time Philadelphia chromosome became quite evident. Spleen was enlarged.
Six months after the manifestation of CML symptoms, she died of blastic crisis with respiratory infection, then no double Ph' was found, 47 chromosomes due to C excess were mixed.
This case suggests us some relation among low LAP score, Philadelphia chromosome and reasonable clinical sign of CML as have been pointed out by many authors.
This case suggests us that both the Philadelphia chromosome and low LAP score do not preceed the other clinical features of CML.
