Fig. 1. (A-C) Peripheral blood film shows significant dysgranulopoiesis in the form of hypolobation of the nucleus, hypogranulation, and abnormal coarse chromatin clumping. Platelet anisocytosis with large and giant platelets were also found. (D, E) Hypercellular bone marrow shows dysgranulopoiesis and many dwarf megakaryocytes (×40, May–Grunwald Giemsa stain). (F) Fluorescent in situ hybridization (FISH) using BCR/ABL1/ASS1 Tri-Color Dual Fusion Probe shows 1 orange aqua (normal ASS1-ABl1 gene), 1 green (normal BCR gene), 1 orange aqua green (from derivative chromosome 9 with ASS1-ABL1-BCR fusion gene), and 2 orange green fusion (from derivative 22 with BCR-ABL1 fusion genes) signals, which are consistent with the presence of an extra Philadelphia chromosome. (G) FISH using TP53/CEP17 probe shows 1 orange (from TP53 gene) and 2 green signals (from centromere of chromosome 17), which is consistent with loss of 1 copy of TP53 gene in concordance with isochromosome 17q.