{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:07:53Z","timestamp":1777932473739,"version":"3.51.4"},"reference-count":62,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic myeloid leukemia (CML) typically presents with fatigue, weight loss, leukocytosis, and splenomegaly. Major bleeding or spontaneous hematoma as the initial manifestation is rare and poses significant diagnostic and therapeutic challenges. This narrative review summarizes published cases of CML presenting first with bleeding or hematoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA-style literature search of PubMed, Embase, Scopus, and Web of Science (up to 8 November 2025) identified case reports and series in which bleeding, hemorrhage, or hematoma constituted the initial presentation leading to the diagnosis of CML. Extracted data included demographics, bleeding site, laboratory findings, management and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-three patients were identified (median age 45 years; range 10-68), 74% male. Bleeding most commonly involved the central nervous system (40%), followed by soft-tissue\/musculoskeletal hematomas (25%), intra-abdominal or visceral bleeding\u2014predominantly splenic (19%)\u2014and ocular\/orbital hemorrhage (13%). Most patients had marked leukocytosis (median WBC \u2248280\u2009\u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L; 87%\u2009\u2265\u2009100\u2009\u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L) and frequent anemia (median hemoglobin 8.5\u2005g\/dL; 71%\u2009&lt;\u200910\u2005g\/dL), with highly variable platelet counts. Defined acquired bleeding disorders were uncommon. Management was medical\/supportive in 47% and surgical or interventional in 36%, particularly for CNS and splenic events. At last follow-up, 62% were alive, 21% had died\u2014mainly from intracranial hemorrhage or splenic rupture\u2014and some survivors had permanent sequelae.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bleeding as the initial presentation of CML, though rare, carries substantial morbidity and mortality, especially with CNS or splenic involvement. Clinicians should consider CML in unexplained major bleeding with marked leukocytosis. Early diagnosis, prompt CML-directed therapy, and site-specific hemorrhage management are crucial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10760296261422761","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T12:39:31Z","timestamp":1777293571000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Review of Bleeding as Initial Presentation in Patients with Chronic Myeloid Leukemia"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6756-6023","authenticated-orcid":false,"given":"Mohammad","family":"ALTermanini","sequence":"first","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Altrmanini","sequence":"additional","affiliation":[{"name":"Qatar University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1393-5302","authenticated-orcid":false,"given":"Abdulrhaman F.","family":"Al-Mashdali","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashraf","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Bridgeport Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Saeed","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Fawzi","family":"Mudarres","sequence":"additional","affiliation":[{"name":"University of Iowa Hospitals & Clinics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Saeed","sequence":"additional","affiliation":[{"name":"Qatar University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ElMustafa","family":"Abdalla","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina","family":"Soliman","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalpana","family":"Singh","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amin","family":"Saied","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0577-7295","authenticated-orcid":false,"given":"Motaz","family":"Almahmood","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aasir","family":"Suliman","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanaa","family":"Qasim","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tareq","family":"Abuasab","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadi","family":"Haddad","sequence":"additional","affiliation":[{"name":"The University of Texas, MD Anderson Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Yassin","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shehab","family":"Fareed","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"issue":"1","key":"e_1_3_2_2_2","first-page":"42","article-title":"WHO 2016 Definition of chronic myeloid leukemia and tyrosine kinase inhibitors","volume":"37","author":"Haznedaro\u011flu \u0130C","year":"2020","unstructured":"Haznedaro\u011flu \u0130C, Kuzu I, \u0130lhan O. 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