Differential diagnosis of CNL (WBC ≥13 × 109/L with neutrophilic predominance)
| Entity . | Neutrophils and bands in blood . | Immature granulocytesa in blood . | Eosinophils . | Basophils . | Monocytes . | Neutrophil morphology . | Megakaryocytes . | Gene fusions . | Mutations . |
|---|---|---|---|---|---|---|---|---|---|
| CNL | ≥80% of WBC | <10% of WBC | <10% of WBC | Usually not increased | <10% of WBC | Normal | Usually normal | None | CSF3R |
| CML | Usually <80% of WBC (except with p230 BCR::ABL1 isoform) | Usually >10% of WBC | Often ≥10% of WBC (especially p190 BCR::ABL1 isoform) | Usually increased | May be ≥10% of WBC | Normal; may be dysplastic in advanced disease | Small and dysplastic- appearing | BCR::ABL1 | No specific |
| MLN-E with TK fusions | Variable | Variable | Usually ≥10% of WBC | May be increased | May be ≥10% of WBC (PDGFRB fusions) | Usually normal | Variable | PDGFRA PDGFRB FGFR1 JAK2 FLT3 ABL1 | No specific |
| aCML | Usually <80% of WBC | ≥10% of WBC | <10% of WBC | Usually not increased | <10% of WBC | Dysplastic | Often small and dysplastic | None | Often SETBP1, ASXL1, or ETNK1 |
| MDS/MPN-NOS | Variable | Variable | <10% of WBC | Variable | <10% of WBC | Often dysplastic | Often small and dysplastic | None | No specific |
| CMML, myeloproliferative | Variable | Variable | Usually <10% of WBC | Usually not increased | ≥10% of WBC | Often dysplastic | Often small and dysplastic | None | Usually SRSF2, ASXL1, or TET2, often in combination |
| Classic MPN with neutrophilia | Variable | Variable | Usually <10% of WBC | May be increased | May be increased | May be dysplastic | Clustered, large, hyperchromatic | None | Usually JAK2, CALR, or MPL |
| MDS with secondary neutrophilia | Variable | Often >10% if due to infection | Usually <10% of WBC | Variable | May be increased | Often dysplastic | Usually small and dysplastic | None | No specific |
| Entity . | Neutrophils and bands in blood . | Immature granulocytesa in blood . | Eosinophils . | Basophils . | Monocytes . | Neutrophil morphology . | Megakaryocytes . | Gene fusions . | Mutations . |
|---|---|---|---|---|---|---|---|---|---|
| CNL | ≥80% of WBC | <10% of WBC | <10% of WBC | Usually not increased | <10% of WBC | Normal | Usually normal | None | CSF3R |
| CML | Usually <80% of WBC (except with p230 BCR::ABL1 isoform) | Usually >10% of WBC | Often ≥10% of WBC (especially p190 BCR::ABL1 isoform) | Usually increased | May be ≥10% of WBC | Normal; may be dysplastic in advanced disease | Small and dysplastic- appearing | BCR::ABL1 | No specific |
| MLN-E with TK fusions | Variable | Variable | Usually ≥10% of WBC | May be increased | May be ≥10% of WBC (PDGFRB fusions) | Usually normal | Variable | PDGFRA PDGFRB FGFR1 JAK2 FLT3 ABL1 | No specific |
| aCML | Usually <80% of WBC | ≥10% of WBC | <10% of WBC | Usually not increased | <10% of WBC | Dysplastic | Often small and dysplastic | None | Often SETBP1, ASXL1, or ETNK1 |
| MDS/MPN-NOS | Variable | Variable | <10% of WBC | Variable | <10% of WBC | Often dysplastic | Often small and dysplastic | None | No specific |
| CMML, myeloproliferative | Variable | Variable | Usually <10% of WBC | Usually not increased | ≥10% of WBC | Often dysplastic | Often small and dysplastic | None | Usually SRSF2, ASXL1, or TET2, often in combination |
| Classic MPN with neutrophilia | Variable | Variable | Usually <10% of WBC | May be increased | May be increased | May be dysplastic | Clustered, large, hyperchromatic | None | Usually JAK2, CALR, or MPL |
| MDS with secondary neutrophilia | Variable | Often >10% if due to infection | Usually <10% of WBC | Variable | May be increased | Often dysplastic | Usually small and dysplastic | None | No specific |
Myelocytes, metamyelocytes, and promyelocytes.