Caption: Hard to believe that the slides are from peripheral blood and not bone marrow! A 35 y/o male with complaint of left upper quadrant pain...Abdominal ultrasound exam revealed splenomegaly, CBC showed WBC: 204'000, HB: 10.6 and platelet 189'000. On peripheral blood smear shift to left with predominance of neutrophils, bands and myelocytes was identified. Fewer than 10% blasts were also seen. The patient was referred for BCR-ABL1 testing with diagnosis of CML. (Slide 6: an incredible increase in buffy coat!) @latif.ajdary