Bleeding Diathesis as the Initial Presentation of Chronic Myeloid Leukemia: A Case Series

Abstract

Chronic myelogenous leukemia, or CML, is another name for chronic myeloid leukemia (CML), a cancer type that starts in certain bone marrow blood-forming cells. The primary initiator of granulocytic proliferation in CML, a myeloproliferative malignancy, is the BCR-ABL1 fusion protein or Philadelphia chromosome. CML is classified into three stages: chronic, accelerated, and blast. It has been widely recognized that the likelihood of developing CML varies by gender, geography, and age. In the chronic phase of CML (CML-CP), bleeding is a rare sign since the thrombocyte and coagulation functions are still adequate. Uncertainties exist regarding the CML bleeding mechanism. We report four cases of CML-CP in adult patients. The majority of these patients had CML and had idiopathic spontaneous bleeding in multiple locations.

Keywords: bcr-abl; chronic myeloid leukemia; chronic phase; philadelphia chromosome; tyrosine kinase inhibitor (tki).

Figure 1. CT of the brain showing intraventricular hemorrhage

CT: computed tomography

Figure 2. The fundus exam of the patient shows retinal hemorrhage and Roth's spots

Figure 3. Ultrasonography of the elbow showing a hematoma