Unfortunately in this situation, only bone marrow examination is needed but enough for decision (blast count), but if you have possibility for cytogenetics, do it. In case of Philadelphia chromosome or only +8 or +21 aberration found, the case can be a CML in advanced phase. If you do not have karyotype, even though if you have ability to use imatinib, you should try it at dose of 400mg as treatment test. If patients is sensitive to imatinib (she is imatinib naïve), response of WBC can be fast, within a month, then try to continue treatment with imatinib and to further escalate dose if possible up to 800mg depending on hematological toxicity. Be aware that in imatinib sensitive case, you might have tumour lysis syndrome. In other case if she fails to respond to imatinib, you can use purinetol, araC or any other leukemic treatment available having in mind that platelets are the most problematic issue in management of any chemo in advanced leukemia. Andrija Bogdanovic, Belgrade, Serbia