DR BURNS: Mrs P is a 41-year-old woman with
chronic myelogenous leukemia (CML). She previously worked as a hairdresser
but has not worked for several months. Mrs P lives with her husband and children.
She has commercial insurance.
For a number of years, Mrs P noted that she felt fatigued and had headaches.
She sought medical care, but no explanation was found. In June 2002, she went
to a new primary care physician and was found to have a white blood cell count
of 58 × 103/µL, hematocrit of 41.4%, and a platelet
count of 211 × 103/µL. There were 51 polys, 2 monocytes,
1 eosinophil, 1 promyelocyte, 13 myelocytes, 14 bands, and 5 metamyelocytes.
A bone marrow biopsy was performed and she was found to have a myeloproliferative
disorder; cytogenetic testing showed classic Philadelphia chromosome (Ph).