Review of Bleeding as Initial Presentation in Patients with Chronic Myeloid Leukemia

BackgroundChronic 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.MethodsA 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.ResultsFifty-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-predominantly splenic (19%)-and ocular/orbital hemorrhage (13%). Most patients had marked leukocytosis (median WBC ≈280 × 10⁹/L; 87% ≥ 100 × 10⁹/L) and frequent anemia (median hemoglobin 8.5 g/dL; 71% < 10 g/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-mainly from intracranial hemorrhage or splenic rupture-and some survivors had permanent sequelae.ConclusionBleeding 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.