257 Pediatric Chronic Myeloid Leukemia Incidentally Diagnosed in a Trauma Patient: A Rare Presentation

Introduction/Objective Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of the BCR-ABL1 fusion gene resulting from the t(9;22)(q34;q11) translocation, commonly known as the Philadelphia chromosome. While CML is well-documented in adults, its occurrence in the pediatric population is rare, accounting for less than 3% of childhood leukemias. Pediatric CML often presents differently than adult cases, with a more indolent clinical course and sometimes atypical symptoms or incidental findings. Early diagnosis and targeted therapy with tyrosine kinase inhibitors significantly improve prognosis. This case report describes an uncommon presentation of pediatric CML identified incidentally during routine blood work for trauma care, underscoring the essential role of laboratory evaluation in uncovering rare hematologic disorders. Methods/Case Report A 13-year-old male with no prior medical history presented following a road traffic accident requiring surgery for a long bone fracture. Routine preoperative blood work revealed a marked leukocytosis (TLC 135 × 109L). Peripheral blood smear showed marked leukocytosis with a full spectrum of granulocytic precursors (myelocytes, metamyelocytes, eosinophils, basophils) without blast predominance. Physical examination was unremarkable, with no organomegaly. Bone marrow aspirate and biopsy demonstrated hypercellularity with granulocytic hyperplasia. Cytogenetic analysis and fluorescence in situ hybridization (FISH) detected the BCR-ABL1 fusion gene t(9;22)(q34;q11), confirming chronic phase CML. Results The diagnosis of chronic phase pediatric CML was established based on clinical, morphological, and cytogenetic findings. The patient was started on tyrosine kinase inhibitor therapy with close follow-up planned. Conclusion This case highlights the rare incidental diagnosis of pediatric CML in a trauma patient, emphasizing the importance of thorough hematological evaluation even in non-hematologic clinical settings. Recognizing CML in children, despite its rarity, is vital for initiating timely and effective treatment, thereby improving prognosis.