A 72-year-old male presented with fever and abdominal pain for 2 days. The fever was continuous in nature without chills or rigor, and was controlled by taking medications. The maximum recorded temperature was 100°F. He also had epigastric pain for 2 days, localized, nonradiating, and burning in character, with no specific aggravating or relieving factors. He also had a history of easy fatigue and decreased appetite. He was a nonsmoker and nonalcoholic with a history of chronic diseases like coronary artery disease, hypertension, and heart failure with reduced ejection fraction (20%) taking medications regularly. On examination, the averagely built patient appeared ill but conscious, calm, and well-oriented to time, place, and person. His vital parameters were within normal limits. Pallor was present on bilateral lower palpebral conjunctiva and skin, and the right supraclavicular lymph node was palpable. Respiratory, cardiovascular, gastrointestinal, and nervous system examinations were normal. At presentation, his hemoglobin level was 3.8 g/dl and a total leukocyte count of 41,800 cells/mm3 with 44% neutrophils, 33% lymphocytes, and 22% monocytes. Random blood sugar, liver, and renal functions were within normal range. Peripheral blood smear revealed normocytic normochromic anemia with leukocytosis and thrombocytosis with blast cells. On bone marrow aspiration, excess blast cells (17%) were seen and advised for bone marrow biopsy that suggested a diagnosis of CMML. Multicolor flow cytometry using CD45 versus scatter gating revealed 21.6% blast/promonocytes of myeloid phenotype with 5% mature monocytic component. Myeloid/monocytic markers/maturation markers such as CD13, CD33, MPO, CD64, and CD36 were positive while immature markers such as CD38, HLA-DR, and CD117 were positive in immunophenotyping. T-cell and B-cell markers were negative. Hence, based on the smear and immunophenotyping findings, a diagnosis of CMML with increased blast/promonocytes was made. The patient is planned for injection of azacitidine 75 mg/m2 for seven days cycle, for a total of six cycles with a total cumulative dose of 117 mg. The patient has completed the fourth cycle of treatment. He is improving clinically with increasing hemoglobin and platelet count, decreasing total leukocyte count, and zero blast cell.