The authors describe a case of chronic myelomonocytic leukemia in which a myeloperoxidase (MPO) deficiency of circulating monocytes was first detected by automated differential cell counting, and subsequently confirmed by cytochemical and immunocytochemical investigations. MPO activity in neutrophil granulocytes from the same case was found to be normal. MPO deficiency in monocytes appeared to be associated with impaired phagocytic capacity and, based on the results of immunophenotypic and ultrastructural studies, was most likely attributable to a partial maturation arrest of monocytes. The present case suggests that MPO deficiency in myelodysplastic syndromes may have its origin in a number of different pathogenetic mechanisms.