A CBC with WBC markedly elevated and BCR-ABL positive. Which diagnosis is most likely?

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Multiple Choice

A CBC with WBC markedly elevated and BCR-ABL positive. Which diagnosis is most likely?

BCR-ABL positivity points to chronic myeloid leukemia. The Philadelphia chromosome creates the BCR-ABL fusion protein that drives a clonal proliferation of myeloid cells, producing a markedly elevated white blood cell count with many granulocytic precursors. This molecular hallmark is not seen in the other listed myeloproliferative neoplasms. Polycythemia vera mainly shows increased red cell mass (high Hb/Hct) and is typically BCR-ABL negative, often with a JAK2 mutation. Essential thrombocythemia features high platelets, usually with CALR, MPL, or JAK2 mutations, not BCR-ABL. Idiopathic myelofibrosis presents with bone marrow fibrosis, teardrop erythrocytes, splenomegaly, and a leukoerythroblastic picture, and is generally BCR-ABL negative as well.

BCR-ABL positivity points to chronic myeloid leukemia. The Philadelphia chromosome creates the BCR-ABL fusion protein that drives a clonal proliferation of myeloid cells, producing a markedly elevated white blood cell count with many granulocytic precursors. This molecular hallmark is not seen in the other listed myeloproliferative neoplasms.

Polycythemia vera mainly shows increased red cell mass (high Hb/Hct) and is typically BCR-ABL negative, often with a JAK2 mutation. Essential thrombocythemia features high platelets, usually with CALR, MPL, or JAK2 mutations, not BCR-ABL. Idiopathic myelofibrosis presents with bone marrow fibrosis, teardrop erythrocytes, splenomegaly, and a leukoerythroblastic picture, and is generally BCR-ABL negative as well.

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