Objective. To determine whether the presence of blue-green inclusions in neutrophils and monocytes should be considered a critical risk result (CRR). Methods. A review of scientific articles published between 2017 and 2023 was performed to assess whether the presence of blue-green inclusions matches the definition of CRR. Results. The finding of blue-green inclusions has been associated with an elevated risk of short-term mortality and is usually associated with severe liver damage. However, it has also been reported in clinically stable patients. Conclusions. Blue-green inclusions should be assessed based on the patient's clinical condition and in conjunction with other laboratory findings. We cannot state that the isolated presence of these inclusions can be considered a CRR.

Las microfotografías 1 - 5 muestran promielocitos anómalos con citoplasma basófilo, cuyos gránulos citoplasmáticos no se observan o, en caso de ser visibles, son muy finos y escasos. Esto se debe al tamaño sub-microscópico de la gran mayoría de los gránulos, característica clave de esta enfermedad. Asimismo, se observa que los núcleos son bilobulados, en aspecto de “reloj de arena” o “alas de mariposa”, la cromatina es abierta y se pueden apreciar nucléolos. La microfotografía 6 muestra dos promielocitos anómalos de aspecto blástico o blastoide, con citoplasma basófilo escaso y  agranular, núcleo no lobulado de borde irregular, cromatina abierta y presencia de nucléolos. La microfotografía 7, para comparación, muestra un promielocito morfológicamente normal (frotis de un paciente no leucémico), con abundantes gránulos citoplasmáticos y núcleo ovalado.

Chronic myeloid leukemia usually presents nonspecific symptomatology, but clinical signs of hyperleukocytosis appear when it progresses to the acute phase. We present a case of hyperleukocytosis associated with acute phase chronic myeloid leukemia that responds to treatment with leukopheresis. The use of this procedure is recommended to reduce symptomatology, but not as definitive treatment of the disease.