Chronic myeloid leukaemia (CML) is a myeloproliferative disorder predominantly of adult life, having a male preponderance.1 These patients have variable presentations.2 Some are completely asymptomatic, their disease being diagnosed incidentally on routine blood CP while others may have symptoms due to anemia or splenomegaly.3 CML is usually diagnosed on peripheral blood film but the detection of the BCR-ABL fusion transcript by molecular techniques is necessary for establishing a definitive diagnosis.4
The basic investigation in the suspected cases of megaloblastic anaemia with pancytopenia include complete blood counts, peripheral blood film examination, reticulocyte count and cobalamin and folate assay.
The diagnosis of TTP in our study was done by demonstration of significant schistocytes (more than 1 percent) on peripheral blood film. The patients were treated with steroids and plasma pheresis and in some cases with weekly Rituximab for 4 weeks.
Clarke and Cheung described a case of metastatic lobular breast cancer diagnosed on a peripheral blood film. (7) The authors described only a scattered infiltrate of these cells in the bone marrow, though, unlike our patient.