78 years old lady went to see her GP with increasing headache, initial management with reassurance and pain control flailed to control her diffuse moderate headache prompted her GP to check her bloods All the other systems examinations were unremarkable   BLOOD TESTS HB 120 WCC560 PLT 430 Norma (N 150-450) Basophilia and eosinophilia noted mainly neutrophils and myelocytes on film Her biochemistry all are within normal range   Bloods film Reviewing the Film by consultant haematologist suggested the diagnosis of chronic myeloid leukaemia in chronic phase She was brought in to the hospital and had emergency assessment and investigations including bone marrow test A final diagnosis of CML  (Chronic myeloid leukaemia) in chronic phase were made and she was commenced on Hydroxycarbamide and Imatinb with allopurionl Learning pint CML is a curable condition prompt assessment is necessary to exclude high count bloods for Hyperleckocytsosis and also to exclude Acute leukaemia Prompt discussion with consultant haematologist is they key for the management of this patients group