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Diagnosis of Chronic Myeloid Leukemia (CML) is most probable given the presence of elevated basophils in the peripheral blood. Basophilia is prognostic of CML, and may also be associated with disease progression and drug resistance.1 Degranulated basophils are sometimes difficult to identify on peripheral smear. Further testing to confirm CML could include cytogenetic analysis for a BCR-ABL translocation (which was positive in this case). Additionally, there are two monocytes present in the image (see black arrows) with abnormal morphology, specifically of the nucleus. Increased numbers of blasts were also seen in this case in the marrow, supporting designation as CML in accelerated phase.

1. Valent P, Horny HP, Arock M. The underestimated role of basophils in Ph+chronic myeloid leukaemia. Eur J Clin Invest. 2018;48(10):e13000. doi:10.1111/eci.13000