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A 51-year-old woman presented with a 3-month history of fatigue and a 2-week history of a nonproductive cough and night sweats. Chronic myeloid leukemia was diagnosed, with a leukocyte count of 398,000 per cubic millimeter. On the basis of suspected leukostasis, sidestream dark-field (SDF) imaging was performed. SDF imaging is performed with a handheld microscope and the use of green light (530 nm) that is absorbed by hemoglobin to visualize the sublingual human microcirculation in real time. At the time of diagnosis, SDF imaging (Panel A and Video 1) showed abnormally large gaps between erythrocytes, probably because of leukocytosis (black arrows). We saw areas of hyperdynamic flow (black arrowhead) next to areas with striking microcirculatory stasis (white arrow) and capillary derecruitment (white arrowheads). After 2 weeks of treatment with hydroxyurea, the leukocyte count normalized, the patient's symptoms diminished, and the microcirculatory flow pattern returned to normal (Panel B and Video 2). We observed restored flow in previously derecruited capillaries and normalization in the gaps between erythrocytes. Approximately 2 years later, the patient underwent allogeneic stem-cell transplantation from her HLA-identical sister and since then has been in good health.
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