Neutrophil numerals Carole Bitar University of Balamand; and Nakhle Saba + Author Affiliations National Institutes of Health Figure View larger version: In this page In a new window Download as PowerPoint Slide A 32-year-old male presented with a 1-month history of fever, weight loss, and worsening fatigue. Physical examination was remarkable for a temperature of 39.5°C and a massive splenomegaly. A complete blood count showed mild normochromic normocytic anemia and marked leukocytosis (~90?000/µL), with basophilia (3500/µL), eosinophilia (5000/µL), and neutrophila/bandemia (80?000/µL). No increase in blast count was noted on peripheral blood or bone marrow examination. Cytogenetic analysis showed translocation t(9;22)(q34;q11), so-called Philadelphia chromosome, resulting in BCR-ABL1 fusion. The patient was diagnosed with chronic myeloid leukemia (CML) and began imatinib therapy. The peripheral smear demonstrated unusually rich polynuclear segmentation generating a complete Arabic numeral list. Panels A through J represent the numbers 0 through 9. This segmentation is secondary to the accelerated myeloid cell production characteristic of CML and other myeloproliferative diseases.