A low white blood cell to neutrophil ratio is not necessarily leukemia because there are many diseases that can cause a decrease in white blood cells and neutrophils, such as viral infections, aplastic anemia, myelodysplastic syndrome, and hypersplenism, among others. However, the presence of leukocytopenia and neutropenia requires us to be alert to the possibility of leukemia. If, in addition to leukocytes and neutrophils, other cells such as lymphocytes and monocytes are significantly elevated in the peripheral blood, it is important to be alert to the possibility of leukemia. A morphological examination of the peripheral blood can be done, and if a large number of primitive and naive cells can be found, the possibility of leukemia is very high.