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How to Make a “Good” Presentation “Great”

• Guy Kawasaki

Remember: Less is more.

A strong presentation is so much more than information pasted onto a series of slides with fancy backgrounds. Whether you’re pitching an idea, reporting market research, or sharing something else, a great presentation can give you a competitive advantage, and be a powerful tool when aiming to persuade, educate, or inspire others. Here are some unique elements that make a presentation stand out.

• Fonts: Sans Serif fonts such as Helvetica or Arial are preferred for their clean lines, which make them easy to digest at various sizes and distances. Limit the number of font styles to two: one for headings and another for body text, to avoid visual confusion or distractions.
• Colors: Colors can evoke emotions and highlight critical points, but their overuse can lead to a cluttered and confusing presentation. A limited palette of two to three main colors, complemented by a simple background, can help you draw attention to key elements without overwhelming the audience.
• Pictures: Pictures can communicate complex ideas quickly and memorably but choosing the right images is key. Images or pictures should be big (perhaps 20-25% of the page), bold, and have a clear purpose that complements the slide’s text.
• Layout: Don’t overcrowd your slides with too much information. When in doubt, adhere to the principle of simplicity, and aim for a clean and uncluttered layout with plenty of white space around text and images. Think phrases and bullets, not sentences.

As an intern or early career professional, chances are that you’ll be tasked with making or giving a presentation in the near future. Whether you’re pitching an idea, reporting market research, or sharing something else, a great presentation can give you a competitive advantage, and be a powerful tool when aiming to persuade, educate, or inspire others.

• Guy Kawasaki is the chief evangelist at Canva and was the former chief evangelist at Apple. Guy is the author of 16 books including Think Remarkable : 9 Paths to Transform Your Life and Make a Difference.

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Need PowerPoint Backgrounds? The Best Places to Check Out [+ Freebies]

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By Lyudmil Enchev

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Having more than 500 million users and being used for an estimated 30 million presentations per day (an amazing 350 presentations per second are started worldwide), PowerPoint , it is no exaggeration to say is a phenomenon. It’s easy to use, a staple in meetings, conferences, classrooms, and now of course for online learning, and completely accessible.

However, familiarity often breeds complacency. Now very long ago, a PowerPoint presentation on its own made a change from long-winded speeches and was enough to motivate an audience. Now, it’s so commonplace you have to think of ways to make your PowerPoint slideshow memorable,  to stand out from the crowd, hold the attention, and capture the imagination and interest of an audience. It’s not easy and there are no guarantees but one quick and easy way to complement your content is using backgrounds .

You’ll be surpassed at the difference they make, and how much a little extra effort and attention to detail can succeed in making your PowerPoint presentation deliver on the day. We’ve put together this complete and comprehensive guide to PowerPoint background, taking you on a tour of sources, creation, and tips alongside practical advice.

In this article: 1. How to import backgrounds into PowerPoint? 2. Places to Find Free PowerPoint Backgrounds 2.1. Free sources 2.2. Premium sources 3. How to make a background on your own 4. Useful Tips When Using PowerPoint Backgrounds

1. How to Import Backgrounds into PowerPoint?

Once you got a background saved, you’re going to need to get it onto the PowerPoint presentation show itself. You can either apply a template to a pre-created slideshow or if this is recommended, start with the template and add to it (from scratch or copy items from your previous creation)  It’s quite easy to do, so let’s look at a break down of the steps.

Let’s imagine you’ve already downloaded and saved a background image onto your computer.

Step 1:  Start PowerPoint, click on File and select New. This will open a series of preinstalled PowerPoint templates and themes options. Step 2:  Click on open. Step 3:  Locate your saved background file, double click to open it, and there you have it.

To add an existing presentation to your new background simply copy and paste.

2. Where to Find Free PowerPoint Backgrounds?

There are many sources for free PowerPoint background and a search on the net will bring up a huge selection. You could spend time trawling through the masses, and sometimes only to find a hidden catch, but we’ve provided you with some of the best free source sites around.

2.1. Free Sources

2.1.1. freepik.

A great and plentiful resource (nearly 1 million images) for any art from vectors and photos but also including PowerPoint backgrounds and other templates. For the free downloads, and there are many to choose from, you will need to attribute the original author. There is information on what exactly is required when you click on your desired background. There are also Premium (no attribution choices). Freepik’s filters (photos, colors, style, etc.) can save you browsing time by taking you straight to the area of interest. Usefully, when you click on a choice you also get recommendations of similar backgrounds so you can expand your search.

2.1.2. Vecteezy

Another huge resource is Vecteezy, with over 1 million images, and 161,787 royalty-free vector graphics and clipart matching PowerPoint backgrounds. You can need to sign up (it’s free but not obligatory) and there are paid versions of varying price structures that offer greater choice and no attribution. If you want free source backgrounds then you’ll need to attribute the author, following the instructions given on each clip. Vecteezy will ease you through the process of choosing by using their comprehensive search filters.

2.1.3. Unsplash

Unsplash is a resource site dedicated to high-quality photographic images. It’s already enormous, with well over a million images and it is growing with photographers from all over the world contributing, so if you are looking for realistic images for your presentation background Unsplash is a great place to start. It’s completely free with no attribution necessary. It really is just a case of finding what you are looking for (filtering through a free search than a series of options) and then clicking the free download button. Save it, then copy it to your PowerPoint slideshow.

2.1.4. Pixabay

Free source website Pixabay shares nearly 2 million photos, illustrations, vector graphics, film footage, and music. Whilst there are only 13 images directly for PowerPoint background that shouldn’t limit you. There is absolutely no reason why you can’t download something without the tag and simply use it on your show. There’s no attribution required and you are free to use it for all purposes. Great filters make finding something suitable a breeze, then it a just a matter of downloading, saving, and using. You also get download pixel size options, which is useful.

2.1.5. PPTbackgrounds

For specific PowerPoint backgrounds, there is a great free site called ppt backgrounds. A fine collection of 2200 free backgrounds for all your presentation needs, suitable for any situation. You can browse categories and search through or use the search bar, so life is easy. Open the image you want, click to open, right-click,  download, and save the image. A really cool feature is each image has color variations, so you can keep a theme but differentiate key slides, areas, or show progress. Click on the colors scale for the Presentation tab.

2.1.6. Free-power-point-templates

Free PowerPoint templates, tell you what it is. Over 12,000 free PowerPoint templates and a whole category on backgrounds. Each modern, trendy template gives specific information and ideas for use, which is handy. You’ve got plenty of scope for browsing and it’s all completely free with no attribution required.

Take a look at GraphicMama’s article  56 Impressive Free Presentation Backgrounds for Outstanding Presentations

2.2. Premium Resources

While it is true that there is a great free source of PowerPoint backgrounds, other templates, and other images that you can use, it must be noted that there are Premium sources that often offer you higher quality, unique options that you can use to really impress your audience.

2.2.1. GraphicMama

As a source for premium design images, Graphic Mama offers a great range of cool and stylish resources for all digital design needs. One category of design is background design bundles and background graphic makers that will help you create outstanding designs. These vector-based backgrounds are prepared on different themes: room interiors, offices, landscapes, abstract, nature, parties, Halloween, Christmas, and more. a bundled theme containing a huge number and variation of choices and styles is available from $32 and includes free updates as the bundles develop over time, so you are never behind the trend. And as they are vector illustrations you won’t lose any quality when you resize, which adds to the versatility, you can use these for printed materials, posters, etc.

Here are some bundles from GraphicMama to whet your appetite.

120 Room Backgrounds Vector Collection

120 rooms of all shapes, sizes, and colors. Using a simple and attractive cartoon style that will add context and entertainment to your presentation whilst not distracting from the content. No limit on usage, so free to do as you please, you also get further updates as and when they come on board.

• Includes 10 high-quality Free Room Interior backgrounds for you to try out.

Vector Backgrounds – Mega Bundle

An enormous bundle of over 240 widely colorful designs on different themes such as Interiors, landscapes, seasons, or even abstract patterns. Truly something for every occasion and all with bright, bold, confident designs that will make your PowerPoint presentation memorable and outstanding.

• Includes 12 high-quality Free landscape backgrounds for you to try out.

1000+ Seamless Pattern Designs Mega Bundle (15 Free Sample Patterns)

• Includes 15 high-quality Free pattern designs for you to try out.

Abstract Backgrounds – Mega Bundle Collection

The backgrounds are ideal for PowerPoint and Google Slides presentations.

2.2.2. ShutterStock.com

Another supplier of premium resources is Shutterstock, with either subscription-based options from $49 per month (10 images) or on-demand packs again from $49 – you can take the opportunity of a 30-day free trial.  Shutterstock has an enormous number of stock images (326 million) and nearly 12,000 specific PowerPoint backgrounds. They have an amazingly precise filter system (color, age, ethnicity, size, categories, etc) so you are guaranteed to find something that fits your theme.

2.2.3. iStockPhoto.com

iStockPhoto sell images and illustration through a subscription or credit-based system. 3 credits are $24 or subscribe from 470 per month, (prices increase depending on the number of images per month). they have a nice range and selection of high quality despite the cost. There are the usual filters to help refine your search and there is an online editor so you can customize your images before purchase.

3. How to Make a Background on Your Own?

despite the number of ready-made options, either free or premium some people still prefer to create their background themselves. we can’t fault you for wanting to be creative, especially if you’ve got the time. So, here are some software options that allow you to get your ideas down.

3.1. Adobe Spark

Adobe design app Spark doesn’t limit itself to presentation backgrounds, allowing you to create social media posts and videos and a whole range of other design options from 12 Euros a month for individuals (first 2 months free). Ideal for creatives   who need something quick and without a great deal of customization, with a series of very impressive professional templates. It’s probably better for social media posts than PowerPoint backgrounds but it could be worth checking out.

3.2. Pixteller

An image and animation maker that can be used for lots of design purposes. It is easy to use and doesn’t require a lot of technical know-how or ability, just some creative thinking. There are templates, ready-made animations, stock photos, and shapes all ready for you to bring together for your concept design. There are 2 paid options pro from $9 per month (graphics)and Diamond from $19 per month (graphics plus animation tool).

A free photo editing platform (you can upgrade to paid pro version) that also works as a design creator. Selecting on wallpaper brings uploads of wallpaper templates, it doesn’t sound so DIY yet. Here’s where you get creative, you can edit the templates with images, and texts. It gives you a base to work with and then lets you go out on your own.

Visme is a data presentation and visualization tool which aims to help transform your ideas into visually appealing presentations and infographics. The basic plan is free for individuals (up to 5 projects) and paid plans start at $14 per month.  A number of high-quality presentation templates, mix and match possibilities, infographic options, and wallpaper options are perfect for creating backgrounds. Get creative using the design tools available and put together something unique and stunning.

4. Useful Tips When Using PowerPoint Backgrounds

Tip 1: modify to make your text pop.

Generally in PowerPoint Presentations, the rule of thumb is to keep text to a minimum, no full sentences, keywords only, and good organization. (don’t read out the slides, please -it’s a guaranteed turn-off). the slides support the speaker, they don’t replace the speaker. With this in mind, when you do use text, let’s make sure it is noticeable. Think of the size, font, typography, color, and style. Don’t go funky just for the sake of it. the style needs to fit with your context, fonts leave subliminal messages (strong and sturdy, trustworthy, professional, creative, imaginative, classy) think carefully about what you are trying to achieve and what message you are trying to get across.

Tip 2: Don’t use too vivid backgrounds

Everybody knows a little about color theory and colors are important. A vivid background color that overly distracts from the main content has done exactly the wrong job. A background adds to the content and works with it -it’s not a battle. A general rule is that cooler colors (blues/greens) often work well for the background, providing a setting for the main information to come alive. Vary colors by all means, but don’t go too bright or too wild, it makes people feel uncomfortable. And remember your content needs to shine through from the background and stand tall – don’t clash.

Tip 3: Think about the audience

Always think of your audience. One of the great things about PowerPoint presentations is that they can easily be customized and edited so use the chance. A great successful presentation that worked in the past is no guarantee of success the next time around. Things change, trends change, styles change and your audience changes too. Examples should be up-to-date and relevant, as should images. People are more and more familiar with presentations these days, they recognize a bog-standard PowerPoint and equally, they recognize something, that has a bit more care and attention.

Tip 4: Think about Branding

Backgrounds are ideal to transmit the idea of your brand. At the simplest level, colors and logos are a must. Consistency in slides and regularly placed branding will leave the audience with a memory imprint. Personalized photographic images where appropriate can also work well in creating a sense of realism and trust -it all goes to build that vital image connection for the listener.

Tip 5: Never forget the author’s rights

I mean – if you are using some free backgrounds, don’t forget to check out the conditions and license types. Some backgrounds need attribution and there is a specific process. Adding a final slide mentioning the authors of the images, or writing them down on the corner of the slides, not only covers you legally but it shows the audience that you are aware of the professional standards and norms to be adhered to. You are a trustworthy, honorable speaker, who is prepared to give credit where it is earned. Nice touch.

Final Words

Let’s make this point again. PowerPoint presentations are so, so common that in order to raise the stakes, we need to make a little more effort. Stand on the shoulders of the familiar presentation and push it forwards. Backgrounds aren’t so difficult but they can make an enormous difference to the overall view of your presentation. They don’t need to take you forever to create, they are a simple, easy, and often free way of creating a lasting impression.

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Lyudmil Enchev

Lyudmil is an avid movie fan which influences his passion for video editing. You will often see him making animations and video tutorials for GraphicMama. Lyudmil is also passionate for photography, video making, and writing scripts.

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Our 25 best presentation backgrounds that grab your attention

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Prezi March 26, 2019

A good background of your presentation sets the stage for the rest of the look and feel, so it’s important to choose wisely. For example, a simple design can elevate the look of your content, but too simple and it can appear unpolished. Meanwhile, a colorful background can provide the foundation for a balanced palette, but one color too many and you’ve got a chaotic mess. A strong contrast can help make a bold statement, but text can easily get lost if the contrast is too high.

The process is certainly delicate, but not impossible. It simply requires thinking a bit deeper about your choice and keeping a couple of tricks in mind. Below, we’ve put together a collection of some of our favorite backgrounds to use in Prezi presentations and a description of why they work. You can find all of the examples below within the Prezi platform.

Using lines and curves in backgrounds to structure your presentation

If you have a hidden line in a photo, you can structure your content so that it follows a particular flow. Keeping your text or topics along the line can also help prevent you from placing content over subjects within a background image (a common mistake that can make your visuals difficult to digest).

1. Iceland in presentation backgrounds

We like this photo of a lone figure in nature because the ice creates a natural direction for content and there’s plenty of room for placement.

2. Coffee mug presentation background

This coffee mug is a nice choice for presenters who don’t want to deliver their content in a specific order. Text or topics can be placed anywhere around the central image, and presenters have the option to use techniques like conversational presenting to share their message.

3. The road forward presentation picture

If your presentation is about a type of journey (whether that’s actual travel, the process of achieving something in your professional life, or something in between), this road-forward image is a great option. The metaphor can be communicated fairly quickly, and the road provides an actual line for your content.

Using negative space in presentation backgrounds

It’s easy to discount empty areas in photos, but when it comes to good backgrounds, negative space can be incredibly useful. Consider spicing up a sparse area with text, shapes, icons, logos, etc. when you want to make them pop.

If slides aren’t your cup of tea, or you’re simply in the mood to try something new, Prezi’s open canvas might be the right change of pace. Prezi users can easily design their presentation within negative spaces by placing topics or stacks of content in them, and navigate to each area as needed. Here’s an example from one of our Prezi Awards winners:

Negative space surrounding your subject or content can also provide a “safe area” in the event that your presentation is printed. Create physical takeaways for your presentation with the exact same content and you can be sure none of your important information will get lost in the margins.

4. Black and white turtle background

We like the recoloring of this image because the dark water provides a space that can make your message really stand out. Pair this image with a memorable statistic in a bold , white font, a heartstring-tugging quote, or whatever message is most important for the audience to remember.

5. Swimmers in presentation backgrounds

This photo makes a great background because it’s an even balance of subjects and empty space. The mid-action shot lends a sense of motion and excitement and would pair well with text or content of a similar sentiment placed on the right-hand side, or around the pier.

6. Snowy paddler background image

The negative space in this snowy paddler image is balanced around the subject, making it a great option if you want to include a few pieces of information in this section of the presentation but convey a sense of equal importance between them.

Using action and flow in presentation backgrounds

While background images are, obviously, in the background, they can actually help drive the presentation if used within platforms like Prezi. See how we take the same backgrounds from the negative space section and turn them into an essential part of the story.

In the swimmer’s photo, for example, our main subject is jumping from the pier. We can, therefore, create a content flow that starts at the pier and finishes in the water, roughly in the spot where he will land. Adding slightly opaque topics like the ones pictured here can help give context to your presentation flow, and retain the full image.

Meanwhile, our black and white turtle is swimming towards the surface of the ocean. We can indicate growth, a journey, or problem-solving by placing topics along the same trajectory.

Lastly, our lone paddler is all about choices. She can either go straight, veer to the left, or head to the shore on the right side. If the story you’re presenting is about a crossroads, or the intention is to present content in a different order each time, a structure that leaves your options open to fit the situation at hand is ideal (think a sales pitch or a project proposal).

Patterns and textures in presentation backgrounds

Sometimes a background with subjects or a metaphor isn’t the right approach to a presentation. In that case, patterns or textures are great for adding visual oomph to your message without getting too detailed. But not every pattern or texture is made equally. Some can be too distracting, or too bold to support your content. Make sure you’re thinking twice before you make your selection.  

Monochrome for good presentation backgrounds

A monochrome background can enhance the colors of your content– no matter what those colors are. The examples below also allow for a strong headline and multiple content flows, since they’re simple and straightforward.

7.  Woven wave presentation background

This woven wave is a great option if you want to give direction to your content but don’t want to include a metaphor of any kind. You can also choose from a wide variety of color palettes since just about everything stands out against black and white.

8. Painted wall presentation image

This painted wall gives you options. You can place your content in a line on the top or the bottom half; either would look natural to the eye. The two halves also suggest categories, should you decide to place your content on the top and the bottom.

9. Water ripple presentation background

Varying shades of the same blue make this watery monochrome background a great option for those looking to add movement or fluidity to their message in an elegant way.

Architectural makes good backgrounds

Architectural backgrounds in presentations are great for modern content. Their edginess or open-airiness is visually attractive, and they often consist of a flat pattern that can support many different content layouts.

10. Cityscape presentation image

Cityscape images make good presentation backgrounds because they give you the feeling of looking up. Try this background if the message you’re trying to communicate is forward-looking or about the promise of a brighter future.

11. Quilted metal background

This quilted pattern is great for when you want to share the information in your presentation in a non-linear order. Because it’s textured and yet flat, your content can live anywhere and be placed in whichever order you choose without being visually confusing.

12. High-rise presentation picture

This tall building naturally causes the eye to gravitate to the top of the image. Use this presentation background when you want to direct your audience’s eyes to a single area.

13. Shifted city background image

Everyone likes a good cityscape, but they can sometimes be so mesmerizing that they detract from the content. By using black and white and a trick of the lens, this photograph is perfect for those who want the scenery to make a subtle urban statement.

Bright colors make good presentation backgrounds

Sometimes you want good presentation backgrounds that offer visual appeal without being too visually appealing. Subtle textures like the options below can, while full of color, easily add depth to content and keep context intact when you’re zooming in and out. And, because they’re flat, you can build almost any kind of presentation on top of them.

14. Moody blue background image

We like this moody blue option because it’s simple, calming, and has enough variation in the hue to remain visually interesting. Try this type of background if your message is meant to be soothing.

15. Greenscape presentation background

This green option screams action, and much like a player’s handbook, or a score sheet, insinuates planning. Try this background if your presentation is about achieving a goal or strategizing a project. Think QBR, a sales kickoff, or even an all-hands company meeting.

16. Blue wave paint presentation background

If your presentation is about creativity, the blue-painted waves in this presentation could be a great option. There’s enough variety in the palette to make it exciting, but not so much that it would detract from your overall message. Content can also be placed in any order and look natural.

17. Bordered bricks presentation picture

The natural border this painted brick background provides can lend your presentation structure, especially if the content itself is meant to be unsystematic. Take this background for a spin if you’re going to try the conversational presenting method.

18. Red wave background

This closeup of a structure in Milan, Italy, is striking for obvious reasons. In a presentation background, its bold color palette can easily be used in combination with neutral content (think black and white) to make a chic statement.

19. Wooden geometry presentation image

The warmth of the wood and the various angles in this photo from Shanghai, China, make it a perfect background for a welcoming message. Try this option if you’re presenting something educational.

20. Blurry confetti presentation background

Blurred backgrounds are great for presentations because they allow the presenter to build content on top of an image that subliminally tells the eye not to focus on it. This blurred confetti background has color, texture, and emotion all wrapped up in one. Try it out if you’re presenting about something cheerful, or really want to get your audience pumped.

Simple presentation backgrounds

Sometimes you don’t need a subject in your background. Sometimes you don’t even need a pattern! In the cases when simple makes the most sense, here are a few recommendations.

21. Dark presentation background image

A dark presentation background is particularly good for stage presentations and bold content. Be sure to use bright text and images for optimal contrast.

22. Bright presentation backgrounds

When your content has a lot of colors, you can try using a neutral background with lots of texture like this one to give extra depth to your presentation.

23. Light blue background images

Light blues are cool and calming– perfect for low-key presentations. With this background, it’s best to put your text in the brightest areas of the gradient.

24. Deep blue background image

Deeper blues are great for professional topics, especially when you want to convey a serious mood.

25. Soft presentation backgrounds

Soft presentation backgrounds are very flexible because they don’t command attention. If you use one that transitions from one color to the next, like this one, try placing your main points on the top and secondary points on the bottom.

How to choose the right presentation background

Selecting the perfect presentation background is a critical step in creating a visually compelling and effective presentation. Here are some practical guidelines to help you make the right choice:

1. Define your presentation’s purpose and audience

Before you start browsing backgrounds for a presentation, take a moment to clarify the purpose of your presentation and understand your audience. Consider questions like:

• What is the main message or theme of your presentation?
• Who is your target audience, and what are their preferences and expectations?
• What emotions or reactions do you want to evoke in your audience?

By having a clear understanding of your presentation’s purpose and your audience’s needs, you’ll be better equipped to choose a background that aligns with your goals.

2. Consider the message you want to convey

Your presentation’s content should drive your background choice. Think about the message you want to convey and how the background can support or enhance that message. Here are a few examples:

If your presentation is about innovation and creativity, a background with vibrant colors or abstract patterns can convey a sense of dynamism.

For a more serious and professional topic, consider using a clean and minimalist background to maintain a professional appearance.

If you’re presenting data or statistics, a background with simple lines or grids can help organize your information effectively.

The following presentation clearly communicates what it’s going to be about with its background image:

3. Balance simplicity and visual appeal

As mentioned earlier, balance is key. Aim for a background that is visually appealing but not overly complex. Too much visual noise can distract your audience from your content. Simplicity can make your message stand out, so choose backgrounds that enhance, rather than overpower, your presentation.

4. Think about color psychology

Colors play a significant role in conveying emotions and messages. Different colors can evoke various feelings and responses from your audience. Consider the following associations when selecting colors for good backgrounds:

• Blue: Trust, professionalism, and calm.
• Red: Energy, passion, and excitement.
• Green: Growth, balance, and harmony.
• Yellow: Optimism, warmth, and positivity.

Choose colors that align with the mood and tone of your presentation. Keep in mind that text and other content on your slides should contrast well with the background color for readability.

The choice of bright yellow ties together with the optimistic and inspiring message of the presentation:

5. Test and iterate

Before finalizing your background choice, create a sample slide with your content to ensure that it looks visually appealing and is easy to read. Test it on various screens and consider how it will appear in different lighting conditions. If something doesn’t work, be willing to iterate and make adjustments until you find the perfect balance.

6. Maintain consistency

Consistency is key to a polished presentation. Once you’ve selected good backgrounds, use them consistently throughout your presentation. This helps maintain a cohesive visual identity and keeps the focus on your content rather than the background.

The colors and elements of the background image stay the same throughout the presentation, providing a coherent viewing experience:

7. Explore Prezi’s options for good backgrounds

If you’re using Prezi for your presentation, take advantage of its background features. Prezi offers a wide range of good backgrounds, including patterns, textures, and images. Use Prezi’s search tool to find good backgrounds that match your criteria, and don’t hesitate to explore different options to find the one that best suits your presentation.

Dos and don’ts of presentation backgrounds

When it comes to good backgrounds, there are certain dos and don’ts to keep in mind to ensure your visuals enhance rather than detract from your message. Here are some key guidelines:

• Consider the message: Think about the core message of your presentation. Does it require a specific mood, tone, or theme? Select a background that aligns with your message. For example, a serene nature background might be suitable for a presentation on mindfulness, while a dynamic cityscape could work well for a business strategy presentation.
• Balance simplicity: Simplicity can elevate the aesthetics of your presentation, but avoid extremes. Too simple, and it may appear unprofessional; too complex, and it can distract from your content. Strive for a balance that enhances your message without overwhelming your audience.
• Use negative space wisely: Negative space within a background can be a hidden gem. Utilize empty areas to add text, icons, or logos, making your content pop. This technique can help guide your audience’s attention to key points.
• Create a visual hierarchy: Arrange your content on the background strategically. Use the background’s elements, lines, or flow to guide the viewer’s eye to the most important information. Ensure a logical visual hierarchy.
• Test for clarity: Before finalizing your background, test it with sample content to ensure readability. Make sure your text contrasts well with the background color or pattern. Avoid backgrounds that make text hard to read.
• Overcrowd good backgrounds: Resist the temptation to clutter your background with too many elements. It can make your presentation look chaotic and difficult to follow. Keep it clean and organized.
• Distracting patterns: While patterns and textures can add visual appeal, be cautious not to choose backgrounds that are overly distracting. The background should complement, not compete with, your content.
• Inappropriate color schemes: Consider color psychology when selecting background colors. For instance, avoid overly bright or clashing colors that might create visual discomfort. Opt for colors that evoke the desired emotional response from your audience.
• Lack of consistency: Maintain consistency in your background design throughout your presentation. Abruptly changing good backgrounds can disrupt the flow and coherence of your message.

Selecting good backgrounds for your presentations is a nuanced process that requires thoughtful consideration. By following these dos and don’ts, you can ensure your background enhances your content, captures your audience’s attention, and helps convey your message effectively. Remember that a well-chosen background can set the stage for a successful presentation.

Learn more about the best presentation design practices by watching the following video:

How to find your perfect images for good backgrounds in Prezi

Adding a background image is a great way to set the look and feel of your presentation — and it’s super easy to do if you’re a Prezi user. You can select a background by using the “Background” sidebar from within the platform itself. From here, you can also change your background color. All of the images we shared in this post were found through this feature. 

Check out the process in the video below.

Adding a couple of keywords to your searches can help source images that are best suited to good backgrounds for your message. Our own designers often add “sparse” or “plain” to their queries in order to pull up options that have plenty of space for topics. You can also search for “texture” or “pattern” if you’d prefer something without a subject at all.

In addition to making background design easy, the search tool within Prezi will also source high-quality images and icons for you to use, so you can design your entire presentation from start to finish without ever leaving the platform.

Easily convert your PowerPoint to a Prezi

If you already have a presentation designed in PowerPoint, we make it easy to take Prezi for a test drive with PowerPoint converter. With Prezi, you can animate your existing set of PowerPoint slides. After importing and selecting which slides you want to keep, simply select your new background, layout, shapes, and colors.

If you’re new to the Prezi-verse, check out some of our favorite presentations on our gallery page . Prezi’s one-of-a-kind open canvas lets you organize and view your presentation as a whole.

Login to start designing your good backgrounds, or sign up for an account to get started.

Choosing the right presentation background may require some thoughtful consideration, but the effort pays off in creating a more engaging and impactful presentation. By aligning your background with your message and audience, you can set the stage for a successful presentation that captures your audience’s attention and effectively conveys your ideas.

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Blog Graphic Design

15 Presentation Background Examples & Templates to Keep Your Audience Awake

By Ryan McCready , Jul 07, 2023

Backgrounds are the foundation for creating an engaging presentation .

A great background can elevate your visual content and help it reach millions of people. But a bad background will make the whole project fall apart.

This is especially true when it comes to presentation backgrounds.

Most of the time, the reader is only going to see the background image once. But with presentations, it’s a whole different story.

Depending on how long your presentation is, that background could be seen 25, 50 or even 100 times!

In fact, according to a recent presentation design statistics study we did, the majority of keynote speakers said their biggest challenge was formatting their slides to keep readers engaged.

So you need to pick something that won’t distract or bore your audience.

Sometimes that’s a very tricky line to walk, but fear not–I have a ton of experience picking the perfect presentation background!

I’ve rounded up 15 great presentation templates to help you pick the ideal background for your presentation. Keep reading to learn how you can pick the perfect background and ace your next presentation!

1. Open Computer Screen Presentation Background

I’m a huge fan of using mockups in my content and design work. If you check out Venngage’s  Gallery , you will see that it’s full of professional poster and flyer mockups.

These mockups are extremely useful because you can instantly place the reader in your shoes. Readers will see a computer screen,  flyer  or another object like it’s sitting right in front of them.

This presentation background example is a simple mockup that almost anyone can use. It would work perfectly as a business background for many purposes beyond presentations too. Check out how the designer used it in the title slide below:

CREATE THIS PRESENTATION TEMPLATE

With an image frame, you can make the computer screen show whatever you want, even the background image:

Learn how to customize this presentation template :

Creating an effective business presentation involves careful planning, organization and effective communication. Save yourself the time and hassle by customizing one of our professionally designed business presentation templates .

2. Zen Garden Presentation Background Image

Plants have been very popular for the past couple of years. If you have ever been in a new trendy restaurant, you definitely know what I’m talking about.

This simple background has the same feel as one of those hip establishments.

This background also embodies the colorful minimalism trend that is blowing up this year. In this case, a simple colorful subject dominates the graphic, but it still feels very light and airy.

And best of all, you can easily use a few different plant background images throughout the presentation. Take a look at how the designer used similar images to create a consistent design:

3. Simple Dot Pattern Background Image

Sometimes you want a presentation background that gives your slides a little bit of texture, without being distracting. I believe that this presentation background embodies that idea pretty well.

It is just interesting enough to catch your eye, but not pull your attention away from what the presenter is talking about.

As you can see in the presentation example below, each slide feels like it has real depth as well. Almost like the icons and information are jumping off the page:

4. Crumpled Paper Presentation Background Image

Realistic flat images always make superb background images, in my opinion. I like to use them when I want to create a minimalist graphic or add something extra to a slide.  

The flat textures and patterns on this simple background are extremely flexible as well!

Like a blank canvas, you can create almost any kind of presentation on top of this background image. It can be used to improve an art lecture, a business meeting or a recycling presentation:

With a simple color filter you can make the background image match your company branding as well:

Check out our presentation design guide . It includes a ton more presentation design hacks like this one.

5. Colorful Circles Presentation Background Image

Looking for a way to add a little color to your presentation? This background may be perfect for you!

It has a ton of white space for you to add content or headers to the slide. And the colorful circles make the presentation seem fun and light.

I would recommend using this background for a presentation that you want to keep casual and fun.

For example, the designers used this background as a title and conclusion slide for a social media presentation:

Remember to pick a color palette that reflects the mood of your presentation.

6. Bold Red Arrow Presentation Background

I would recommend finding a background before you start designing your presentation. This way you can create the slides around the background image.

With the right background image, you can give your slides structure and direction. Or at least improve the layout of your presentation .

Check out how the designers used this background image to improve the slides. The arrow of the background image perfectly fits the topic of the presentation.

And because it’s used on the title slide, it will put the audience in the right headspace from the beginning.

7. Split Slide Presentation Background Example 

This example is one presentation background that everyone has probably used a few times. I wouldn’t be surprised if it was part of the first presentation software ever.

It may be extremely simple, but it’s just as effective all these years later. That’s because you can use this on any presentation topic or in any industry. Get your message across in a simple but powerful way with these simple presentations templates .

This ease of use and flexibility will help you create a killer presentation in no time. Take a look at how it was used throughout the slides below:

8. Subtle White Grid Presentation Background

Like the white paper example above, this image will give your presentation background a lot of subtle depth. It’s engaging enough to grab someone’s attention, but not enough to distract from the written content.

I really like how the texture differs from one square to the next. It makes the whole image a lot more interesting to the eye.

Plus the white color palette will make it easy to place text, graphs or charts directly on top of it. This will ensure that your presentation isn’t cluttered or messy. Take a look at how it’s used in the presentation example below:

9. Purple Gradient Presentation Background Image 

If you haven’t heard, gradients are super popular and will be for the next few years. No, we haven’t gone back in time to the 1990’s — gradients are really back.

Gradients make great background images because they are unique and futuristic. If you want to stand out from the crowd, this background is perfect! Plus these color transitions look spectacular on HD screens and social media.

As you can see below, the white text and icons really jump off the page when placed on top of a gradient:

And you can make a gradient out of literally any combination of colors that you want:

10. Flat Typographic Background Image

Typography is a key part of effective design.

I really like this background image because it will add a lot of character to a slide or presentation. The subtle shadows and highlights actually make this black and white photo seem colorful as well.

A background image like this is very versatile because you can use a few different color palettes with it. Not many colors are going to clash with that monochrome photo.

And if you use a vivid color palette, which is very trendy this year, the colors will very eye-catching. Take a look at how great the different palettes look below:

11. Checkerboard Texture Presentation Background

If you are tired of using a flat background image, but not ready for something too flashy, this background texture is perfect for you!

As you can see, it uses the classic checkerboard pattern to break up the background layer. However, because the pattern is also flat, it won’t distract from your presentation content.

I would recommend using this pattern to add a clear visual break between sections, kinda like they did in the slides below:

Presentation slides play a crucial role in creating an engaging presentation. Browse our selection of engaging presentation templates to enhance your message and make it easier for your audience to understand and remember key points.

12. Geometric Pattern Presentation Background Image

This is one of the most interesting background images in the entire roundup, in my opinion. The bold colors and creative patterns will make the whole presentation feel extra exciting.

Another great feature of this background is that it can be used with a ton of different palettes. Go ahead, pick a color from the geometric pattern, and then use it throughout your slides.

13. Flat Creative Presentation Background Image Example 

Set the tone for your creative presentation from the start with this trendy background image. If you weren’t aware, succulents and plants are very trendy this year in creative circles.

The open section at the top of this background is the perfect spot to add a header or title as well. Check out how they used it in the title slide below:

Plus the bold colors of this image help you pick the color palettes of the other slides:

For more captivating presentation ideas , check out our selection of creative presentation templates .

14. Arrows Everywhere Subtle Background Texture 

A simple background like this can add some serious depth to your presentation. Or blog post.

With a myriad of textures, directions and sizes, the triangles will effortlessly draw the eye. I would recommend using this background in a tech and marketing presentation.

Also, you should try to stick to a geometric or minimalist theme for your slide. In the example below, they choose to use other simple shapes and it blends together extremely well:

15. City Skyline Background Image Example

Finding a subtle background image is hard, especially if you want to use a stock photo . A lot of the time they divert attention from the content on the screen.

Or, even worse, they don’t match your presentation’s color palette and theme. This city background is ideal because it has such a neutral color palette. Take a look at how well it matches the other slides below:

You can also use a color filter to make it a little less distracting and match your presentation theme:

City landscapes can be versatile and work well with a variety of presentation topics, especially with business presentations. Have a presentation coming up? Check out our gallery of pitch deck templates to deliver the perfect presentation.

Create an engaging presentation

Now that you made it to the end of our presentation background roundup, I would recommend checking out our collection of simple backgrounds :

35+ Simple Background Images, Templates & Design Tips

And if you want to learn more about using stock photos , read this first:

10 Simple Ways to Incorporate Stock Photos Into Your Designs

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• Published: 26 April 2024

Hematological, clinical, cytogenetic and molecular profiles of confirmed chronic myeloid leukemia patients at presentation at a tertiary care teaching hospital in Addis Ababa, Ethiopia: a cross-sectional study

• Fekadu Urgessa 1 , 3 ,
• Boki Lengiso 1 , 6 ,
• Aster Tsegaye 1 ,
• Amha Gebremedhin 2 ,
• Fozia Abdella 2 ,
• Fisihatsion Tadesse 2 ,
• Jerald Radich 4 ,
• Helen Nigussie 3 &
• Teklu Kuru Gerbaba 3 , 5  

BMC Cancer volume  24 , Article number:  530 ( 2024 ) Cite this article

Metrics details

In low-income countries there is insufficient evidence on hematological, clinical, cytogenetic and molecular profiles among new CML patients. Therefore, we performed this study among newly confirmed CML patients at Tikur Anbesa Specialized Hospital (TASH), Ethiopia.

To determine the hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at tertiary care teaching hospital in Addis Ababa, Ethiopia.

A facility-based cross-sectional study was conducted to evaluate hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at TASH from August 2021 to December 2022. A structured questionnaire was used to collect the patients’ sociodemographic information, medical history and physical examination, and blood samples were also collected for hematological, cytogenetic and molecular tests. Descriptive statistics were used to analyze the sociodemographic, hematological, clinical, cytogenetic and molecular profiles of the study participants.

A total of 251 confirmed new CML patients were recruited for the study. The majority of patients were male (151 [60.2%]; chronic (CP) CML, 213 [84.7%]; and had a median age of 36 years. The median (IQR) WBC, RBC, HGB and PLT counts were 217.7 (155.62–307.4) x10 3 /µL, 3.2 (2.72–3.6) x10 6 /µL, 9.3 (8.2–11) g/dl and 324 (211–499) x 10 3 /µL, respectively. All patients had leukocytosis, and 92.8%, 95.6% and 99.2% of the patients developed anemia, hyperleukocytosis and neutrophilia, respectively. Fatigue, abdominal pain, splenomegaly and weight loss were the common signs and symptoms observed among CML patients. Approximately 86.1% of the study participants were Philadelphia chromosome positive (Ph+) according to fluorescence in situ hybridization (FISH). P210, the major breakpoint protein, transcript was detected by both qualitative polymerase chain reaction (PCR) and quantitative real time polymerase chain reaction (PCR).

During presentation, most CML patients presented with hyperleukocytosis, neutrophilia and anemia at TASH, Addis Ababa. Fatigue, abdominal pain, splenomegaly and weight loss were the most common signs and symptoms observed in the CML patients. Most CML patients were diagnosed by FISH, and p120 was detected in all CML patients diagnosed by PCR. The majority of CML patients arrive at referral center with advanced signs and symptoms, so better to decentralize the service to peripheral health facilities.

Peer Review reports

Chronic myeloid leukemia (CML) is a hematopoietic stem cell (HSC)-derived myeloproliferative disorder caused by chromosomal translocation (9; 22). The formation of the Philadelphia (Ph) chromosome and the expression of the breakpoint cluster region (BCR)-Abelson murine leukemia viral oncogene homolog 1 (ABL) fusion gene result from the fusion of a portion of the BCR on chromosome 22 with the ABL tyrosine kinase on chromosome 9 [ 1 , 2 ]. Cytogenetic evidence of the Philadelphia (Ph) chromosome, a reciprocal translocation between the long arm of chromosome 22 at the BCR gene and chromosome 9 at the ABL gene, can be found in more than 95% of CML patients (9;22). As a result, a BCR-ABL fusion gene is formed, resulting in the production of a chimeric protein with constitutively active tyrosine kinase activity [ 2 , 3 , 4 , 5 ].

CML is characterized by anemia, thrombocytosis, and left-shifted leukocytosis [ 6 ]. Most cases of CML can be diagnosed using peripheral blood findings combined with molecular genetic techniques that detect t(9; 22) (q34.1; q11.2) or, more specifically, BCR::ABL1. A bone marrow aspirate, on the other hand, is required to ensure sufficient material for a complete karyotype and for morphologic evaluation to confirm the disease phase [ 7 ]. Patients in the chronic phase of CML have less than 10% blasts in their bone marrow samples [ 8 ]. The accelerated phase of CML is distinguished by bone marrow samples containing 10–20% blasts. The CML blast crisis phase has the same picture as acute leukemia; this stage contains more than 20% blasts, and large clusters of blasts are observed in the bone marrow and spread to tissues and organs other than the bone marrow [ 8 , 9 ].

Molecular tests such as PCR and FISH for t(9;22) (q34;q11.2), which demonstrate BCR-ABLs, are essential for the diagnosis and confirmation of CML [ 10 , 11 ]. The goals of treatment for chronic phase CML are to avoid progression to other advanced stages and to avoid adverse events (AEs) to restore and maintain quality of life so that patients can achieve a life expectancy comparable with that of the general population [ 12 ]. Hydroxyurea (HU) is an S-phase agent that acts by inhibiting DNA synthesis. This drug acts as an inhibitor of ribonucleotide reductase and can lower blood counts within 1 to 2 days, especially if higher than standard doses are used [ 13 ]. Tyrosine kinase inhibitors (TKIs) are potent drugs that significantly improve long-term outcomes in patients with CML [ 14 ].

In the developed world, early diagnosis at an average age of approximately 65 years is common, and most cases are chronic. In contrast, in low-income countries, CML is more commonly diagnosed in the advanced stage and in the younger age group (39 years) [ 3 ]. Early diagnosis and treatment of CML are highly important for preventing and controlling CML as its diagnosis and treatment delay worsen because the disease may progress to clonal mutation and the development of resistance to TKI therapy [ 13 ]. Besides, in low-income countries there is insufficient evidence on hematological, clinical, cytogenetic and molecular profiles among new CML patients. Ethiopia is among the low-income and resource-constrained countries where there is limited evidence on the status of new CML patients. Thus, the aim of this study was to determine the hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients during their first presentation at TASH, Addis Ababa, Ethiopia.

Methodology

The study was conducted at TASH hematology clinics, a tertiary care center affiliated with the College of Health Sciences, Addis Ababa University (AAU). TASH was the largest referral hospital in Ethiopia. Patients with CML from all around the country were sent to this institution to be enrolled in the Glivec International Patient Assistance Program and receive treatment (GIPAP).

A cross-sectional study was conducted among confirmed chronic myeloid leukemia patients who were first diagnosed at TASH between August 2021 and December 2022. The study population included CML patients who were diagnosed and confirmed by Xpert BCR-ABL Ultra, FISH and RT‒PCR as CML patients for the first time at TASH hematology clinics. Excluded patients included those with suspected CML who were BCR-ABL, FISH and RT‒PCR negative and confirmed to be CML negative; patients who did not voluntarily provide blood samples; and patients who were extremely ill and unable to provide consent and samples.

A convenient sampling technique was used for all the newly diagnosed patients enrolled during the study period. All CML patients diagnosed between August 2021 and December 2022 were included consecutively to determine the hematological, clinical, cytogenetic and molecular profiles. Accordingly, 251 CML patients were recruited for the study.

Sample collection and laboratory analysis

Blood samples with a volume of 5 mL were collected in an EDTA test tube from all study participants by a certified laboratory expert. Hematological analysis was performed using a Unicel DxH800 at TASH according to the SOPs within a maximum of 8 h following collection. The CBC was analyzed with a Beckman Coulter DxH 800 automated hematology analyzer based on the manufacturer’s recommendations.

For molecular profiles, one of the results used for confirming CML was the Xpert BCR-ABL Ultra test. In vitro diagnostic tests for the quantitation of BCR::ABL1 and ABL1 mRNA transcripts in peripheral blood specimens from patients diagnosed with t(9;22)-positive CML expressing the BCR-ABLl fusion transcripts type e13a2 and/or e14a2 have been performed. The test utilizes automated, quantitative, RT‒qPCR, but it could not differentiate e13a2 from e14a2. The Xpert BCR-ABL Ultra test is intended to measure BCR::ABL1-to-ABL1% ratios on the International Scale (IS).

The other test used for the study was the FISH technique for the initial screening of CML patients via both bone marrow and peripheral blood. The RT‒PCR results were also consistent with the results of other tests we used for the present study, and these results constitute the gold standard for diagnosing and monitoring BCR::ABL1 transcript mRNA in CML patients. All FISH, qualitative and quantitative RT‒PCR were performed abroad in India for all patients.

Quality assurance

The overall activities of data collection were monitored by the principal investigator to maintain the validity of the data during data collection. There was strict supervision during the data collection, and the collected data were checked for completeness, accuracy, clarity, and consistency by the supervisors on a daily basis and by the principal investigator. The samples were verified for hemolysis, clotting, volume, collection time, and proper labeling before proceeding to the analytical procedure. The manufacturer’s procedures, as well as safety precautions and specimen handling procedures, were strictly followed.

The analysis was performed by a senior laboratory technologist. Standard operating procedures were used for specimen processing to maintain good quality. The performance of the automated hematology analyzer was checked by running three levels of hematological cell controls (normal, low and high). The results of complete blood counts were registered as the exact number (value) in a standardized recording format. All laboratory assays were carried out following standard operating procedures (SOPs) by trained and experienced medical technologists.

The data collected were cleaned, checked for completeness and entered in Excel spreadsheet. The data were subsequently exported to the Statistical Package for Social Sciences (SPSS) version 26. The data were analyzed using SPSS. Descriptive statistics were used to analyze the sociodemographic, hematological, clinical, cytogenetic and molecular profiles of the study participants. The distribution of the data was checked, and the median and IQR were used for non-normally distributed data.

Operational definitions

Hgb value < 13 g/dl for males and < 12 g/dl for females. Severe anemia ≤ 7 g/dl, moderate anemia 7.01–10 g/dl, mild anemia 10.01–12 g/dl for females and 10.01–13 g/dl for males.

when a basophil count > 300 cells/µL is found in blood.

Clinical profile

Signs and symptoms of CML patients during presentation.

Confirmed new CML patient

Xpert BCR-ABL Ultra or FISH- or RT‒PCR-positive patients confirmed for the first time as CML patients at TASH hematology clinics.

Eosinophilia

when the eosinophil count is > 500 cells/µL in blood.

Hyperleukocytosis was defined as a WBC greater than 100,000/µL found in blood.

Neutrophilia was defined as a higher neutrophil count (> 7.9 × 103/µL). Prechemotherapy naive if the patients never received HU treatment

Pre chemotherapy treated Patients who had received HU treatment

Splenomegaly

Spleen swelling of the categorized size; massive splenomegaly > 10 cm, moderate 4–9 cm and mild size of 1–3 cm.

Thrombocytopenia

a PLT < 150 × 10 3 cells/µL found in blood.

Thrombocytosis

a PLT > 450 × 10 3 cells/µL found in blood.

Sociodemographic characteristics of the study participants

A total of 251 CML patients were diagnosed and included in the study. Among the total study participants, 107 and 144 were naïve and HU-treated, respectively. More than half (60.2%, 151) of the patients were males. The median age of the study participants was 36 (IQR (29–47) years, and more than 91% of the study participants were ≤  60 years old. More than 51% and 44% came from rural area and travelled more than 300KM distance to reach the TASH, respectively. The median for duration with symptoms of our study participant was five months (Table  1 ). And the time it takes from initial diagnosis to confirmation was approximately two weeks since most of the patients should send the sample to abroad for confirmation.

Hematological profile of the study participants

The median (IQR) WBC count was 217.7 (155.62–307.4) ×10 3 /µL, which was determined for patients who were both naïve and treated with HU during presentation. The median (IQR) WBC counts for patients who were naïve and treated with HU were 261.2 (186.6-349.7) × 10 3 /µL and 188.3 (139.3-290.73) ×10 3 /µl, respectively, during presentation. For the absolute neutrophil count (ANC), the overall median (IQR) was 174.8 (111.3-263.6) x10 3 /µL, whereas for patients naive and treated with HU, the median (IQR) was 201 (137.12–295.6) x10 3 /µL and 145.25 (97.2-241.57) x10 3 /µL, respectively.

For RBC parameters, the median (IQR) value for RBC was 3.2 (2.72–3.6) x10 6 /µL. The median (IQR) RBC counts for patients who were naïve to treatment and those treated with HU were 3.05 (2.7–3.6) ×10 6 /µL and 3.3 (2.72–3.75) ×10 6 /µL, respectively. With respect to the PLT, the median (IQR) value was 324 (211–499) x10 3 /µL. The median (interquartilerange (IQR)) PLTs for patients naïve and treated with HU were 322 (211–447) ×10 3 /µL and 324.5 (211-508.75) ×10 3 /µL, respectively. There were significant differences in hematological parameters, such as the WBC count ( P  < 0.001 ), HGB count ( P  = 0.024 ), and HCT count ( P  = 0.024 ), between naive and HU treated groups (Table  2 ).

Common hematological abnormalities among new CML patients

All patients had leukocytosis, and greater than 95.6% of the patients had hyperleukocytosis. Among the study participants, 233 (92.8%) CML patients developed anemia, and moderate anemia was common among 136 (54.2%) CML patients, followed by mild anemia 76 (30.3%) and severe anemia 21 (8.4%) during presentation. The percentages of CML patients with eosinophilia and basophilia were 96.5% and 88.5%, respectively. However, the medians (IQRs) for eosinophils and basophils were 2.3 (1.4–3.85)% and 1.1 (0.3–3.3)%, respectively, of the total WBC count (Table  3 ).

Distribution of common hematological abnormalities among patients in the CML phases

Among the 91 HUnaïve and 122 HUtreated CP CML patients, 90 (98.9%) and 113 (92.6%) had hyperleukocytosis, respectively. Most CP-phase WBCs fell in the range of 100–250 × 10 3 /µL, whereas 33 (15.5%) CP and 10 (33.3%) AP patients had  ≥  351 × 10 3 /µL WBC counts. In the AP CML phase, 29 (96.7%) patients had hyperleukocytosis, whereas all eight BC CML patients had hyperleukocytosis. Among the 91 HUnaïve and 121 HUtreated CP CML patients, 58 (63.7%) and 55 (45.1%) had moderate anemia, respectively. Among the phases, 89.2% and 90% of the CPs and APs, respectively, developed anemia, whereas only one BC CML patient treated with HU was free from anemia. Regarding the PLT, of the 91 HUnaïve and 121 HUtreated CP CML patients, 54 (59.3%) and 70 (57.4%) had normal PLTs, respectively. Furthermore, thrombocytopenia was observed in 27 (12.7%), 3 (10%) and 4 (50%) patients in the CP, AP and BC CML phases, respectively. Thrombocytosis was observed in 62 (29.1%) patients with CP, 10 (32.2%) with AP and one patient in the BC CML phase. For the neutrophilic distribution, except for one patient in the CP CML phase, there was neutrophilia in all phases of CML.

Clinical profile of the study participants

Among 251 study participants, 213 (84.7%) were at the CP stage, 30 (12%) were at the AP stage, and 8 (3.2%) were at the BC stage. The majority of CML patients were symptomatic at the time of presentation; the most common symptoms were fatigue (242; 96.4%), abdominal pain (231; 92%), splenomegaly (232; 92.4%) and weight loss (221; 88%) (Fig.  1 ). The prognostic risk scores of all the study participant were calculated (Table  4 ).

Clinical profile of confirmed CML patients at presentation

Splenomegaly is one of the main symptoms of patients. A massive, moderate or mild increase in spleen size was indicated. Among the 232 study participants who had splenomegaly, 62.9% had massive splenomegaly with a spleen size > 10 cm, 34.9% had moderate splenomegaly with a spleen size of 4–9 cm, and 2.1% had mild splenomegaly with a spleen size of 1–3 cm. Approximately  85% of CPs had splenomegaly, whereas only one AP and one BP CML patient were free from splenomegaly.

Cytogenetic and molecular profiles

All of the study participants were positive for the Philadelphia chromosome or BCR::ABL1, and the p210 BCR::ABL1 fusion transcript was detected. After cytogenetic analysis of 251 confirmed CML patients, FISH was performed for 222 (88.5%) CML patients; 216 (97.3%) were Philadelphia chromosome positive (Ph+), whereas in six patients Philadelphia was absent or negative. The median (IQR) number of Ph + cells per 100 cells was 95% (85–100%) among the study participants diagnosed and positive by FISH. Among the Ph + cases, the distributions of CML phases were 85.6%, 11.6% and 2.8% for CP, AP and BC, respectively. Except for one AP patient, all the other Ph-negative patients were CP CML patients.

The remaining 35 (13.9%) patients were diagnosed by the Xpert BCR-ABL Ultra test (GeneXpert, Cepheid) (twety three) ( 23 ) and by quantitative (six) and qualitative (six PCR. In our study area, for new patients, the Xpert BCR-ABL Ultra test (RT‒PCR) was performed for patients who cannot afford FISH (which is performed abroad). The Xpert BCR-ABL Ultra test results showed that 20 (87%) of the new CML patients had > 55% (above the upper LoQ), which indicated that BCR::ABL1 L fusion was detected at a level > 55% (IS). Qualitative PCR was performed for six patients who were FISH negative, and p210 (BCR/ABL), the major breakpoint protein, transcript was detected. Among the transcripts identified by both quantitative and qualitative PCR, all the detected transcripts were of the major breakpoint protein, p210 (BCR/ABL), which is frequently encoded by the e13a2/e14a2 isoforms.

CML is characterized by anemia, thrombocytosis, and leukocytosis with a shift to the left. Molecular tests such as PCR and FISH for t(9;22) (q34;q11.2), which demonstrate BCR-ABLs, are essential for the diagnosis and confirmation of CML [ 10 , 11 ]. However, the data related to hematological, clinical, cytogenetic and molecular profiles of CML patients is very limited in low-income countries as a result we motivated to describe these profiles among CML patients during presentation.

The median age was 36 years, and more than 91% of the study participants were ≤  60 years old. This finding is consistent with the study conducted by Mulu Fentie A et al., which reported a total of 27.2% of patients aged 31–40 years [ 15 ]. These findings are comparable with those of the studies conducted by Tadesse F et al., in which the median age was 33 years [ 3 ], and by Ngono AP et al., in which the mean age was 39.2 years [ 1 ]. This shows that younger populations were affected by CML. In this study, males (60.2%) were more affected by CML than females were, with a ratio of 1.5:1. This finding is also similar to that of a study conducted in Pakistan, in which the male-to-female ratio was 1.6:1 [ 16 , 17 ]. This finding is also similar to that of a study conducted in Iraq in which 57.1% of the participants were male (Al-abady I et al., 2021) [ 18 ]. These findings may support the finding that CML affects younger individuals aged 39 years in low-income countries [ 3 ], although the reason why younger individuals are affected by CML is not clear in developing countries.

Among 251 study participants, 213 (84.8%) were in the CP, 30 (12%) were in the AP and 8 (3.2%) were in the BC. These findings are similar to those of Kumar S et al., who reported that 83% of CML‑CP, 12% of AP, and 5% of AP patients were in the BC phase in India [ 19 ]. Furthermore, a study from India by Srinivas KG et al. reported comparable findings: CP (90.1%), AP (4.5%) and BC (5.4%) [ 20 ]. However, our findings were inconsistent with those of Ngono AP et al. in Cameroon, especially for CP-CML (66%) [ 1 ], and with those of Sinha R. et al. [ 21 ] in India. Sinha et al. reported that 28.1% of patients were in the AP phase, which is higher than our finding (12.1%). Similarly, there were fewer findings in the BC phase than in Cameron, 22.7% of which were reported by Ngono AP et al. and 7.8% by Sinha R et al. in India [ 1 , 21 ]. This difference could be due to the difference in sample size since the sample sizes for both patients were much smaller than our sample size and because of the difference in duration of symptoms. Furthermore, advanced-stage CML was prevalent, possibly because patients were diagnosed at advanced stages because of late detection, the lack of facilities available to detect CML at peripheral health facilities and poor culture available to visit health facilities for health checks.

The median (IQR) WBC count was 217.7 (155.62–307.4) ×10 3 /µL, and all patients had leucocytosis, whereas 95.6% had hyperleukocytosis. This finding is similar to that of the study conducted by Tadesse F et al., which revealed that all the patients had leukocytosis [ 3 ]. Similarly, in a study conducted in Iraq by Al-abady I et al., the mean WBC count was 153.7 × 10 9 /L, ranging from 29 to 436 × 109/L. Furthermore, in a study performed in Tanzania by Henke O et al., the median WBC was 300.5 × 10 9 /L (78–499 × 10 9 /L) [ 22 ]. This finding was also consistent with those of studies conducted by Ngono AP et al., Kumar et al. and Wiyono et al. [ 1 , 6 , 19 ]. Leukocytosis is expected in CML patients, but as most of the study participants had hyperleukocytosis, this could make diagnosis difficult because the patients need to come to TASH frequently and be forced to take HU for a longer time as the WBC count decreases to the recommended number (20–30 × 10 9 /L and clinical parameters also considered) to start chemotherapy. This could also explain why CML patients dropped out before starting chemotherapy (imatinib, a first generation TKI) in our study area.

For the absolute neutrophil count (ANC), the median (IQR) value was 174.8 (111.3-263.6) x10 3 /µL during presentation. Patients who were naïve to treatment or treated with HU had 201 (137.12–295.6) x10 3 /µL and 145.25 (97.2-241.57) x10 3 /µL ANC, respectively. Our study showed that almost all (99.2%) of the participants had neutrophilia, which is in line with the results reported from Tanzania by Tebuka E et al. (ANC 179(± 123) K/µL) [ 22 ]. In addition, our study revealed that 88.5% of the study participants had basophilia, although the relative percentage median (IQR) was 1.1 (0.3–3.3)%, which is comparable with the findings of Al-abady et al. [ 18 ]. . Neutrophils are among the WBC components that are expected to increase in CML patients; as a result, neutrophilia was observed in almost all the study participants. In addition, basophil formation is usually observed in CML patients; as a result, basophilia was also prevalent, although the relative percentage is dominated by neutrophils. However, neutrophilia and basophilia were also observed among patients treated with HU because either the patients took HU for short days or they took a low dose during presentation.

For Hgb, the median (IQR) value was 9.3 (8.2–11) g/dl. The median (IQR) values for patients who were naïve to treatment and treated with HU were 8.9 (7.9–10.2) g/dl and 9.75 (8.33–11.2) g/dl, respectively. Approximately 19(7.4%) had severe, 138(53.9%) moderate and 78(30.4%) mild anemia which was comparable with study conducted by Tadesse F et al. that reported 96.7% of CML patients had anemia [ 3 ]. These findings are also similar to those of a study by Kumar S et al., in which 13% had severe anemia, 58.8% had moderate anemia and 28.2% had mild anemia [ 19 ], and those of Ngono AP et al., in which 86.4%, 61.4% and 5.3% had moderate, respectively [ 1 ]. Furthermore, a study conducted by Chang F et al. revealed that 95.1% of patients developed anemia and mild anemia (22.8%) and moderate anemia (46.9%), but these proportions differed for severe anemia (30.1%) [ 16 ]. The difference may be due to sample size, duration of symptoms and geographical location. As expected, the incidence of anemia was high, and moderate anemia was the dominant anemia among the study participants; this was also related to the clinical stage at which the patients came to our study site, TASH.

With respect to the PLT, the median (IQR) value was 324 (211–499) x10 3 /µL during presentation. The medians (IQRs) of the PLTs for patients’ naïve to treatment with HU were 322 (211–447) ×10 3 /µL and 324.5 (211-508.75) ×10 3 /µL. Approximately 73 (29.1%) and 34 (13.5%) patients had thrombocytosis and thrombocytopenia, respectively. These findings were consistent with those of the study conducted by Ngono AP et al., which reported that a normal PLT was found in 80 (60.6%) patients, 11 (8.3%) had thrombocytopenia, and 41 (31.1%) had thrombocytosis [ 1 ]. In addition, our findings were comparable with those of a study conducted by Tadesse et al., which revealed that 23.3% of the study participants had thrombocytosis [ 3 ], however, there is some variation, which could be due to sample size differences or variations since our sample size was larger than those in those studies. In addition, this was an indication of the variation in the PLT among CML patients, which could be normal in some cases but thrombocytosis in others.

The duration of symptoms in our study participants (median (IQR)) was 5 (2.25-12) months, with a range from 0 to 60 months. These results were comparable with the results reported from Tanzania by Tebuka E et al., in which the duration of symptoms was 15 (± 9) months, ranging from 0 to 48 months [ 23 ]. All CML patients in this study were symptomatic at the time of presentation, and the common complaint was fatigue (96.4%), followed by abdominal pain (92%), splenomegaly (89.2%), weight loss (88%) and abdominal swelling (80.5%). These findings are in line with the findings of studies conducted by Sultan S et al., Al-abady I et al. and Sinha R [ 17 , 18 , 21 ]. This percentage was greater than that in the study by Srinivas KG et al. ., which revealed that the common presentations were fatigue (60%), fever (48%), weight loss (37%) and splenomegaly (20%). Another Indian study revealed that fullness in the abdomen was 66.6%, fever was 59%, and fatigue was 55.5% [ 19 ]; these findings can be attributed to differences in sample sizes among studies, environmental factors and durations of symptoms.

Splenomegaly (92.4%) presented in different categorical sizes in this study; 146 (62.9%) patients had massive splenomegaly, 81 (34.9%) developed moderate splenomegaly, and 5 (2.1%) had mild splenomegaly. These findings are comparable with the study performed by Tadese F et al., whose overall range was 3–26 cm [ 3 ] since most of the findings in our study indicated moderate and massive splenomegaly. Additionally, the prevalence of splenomegaly was comparable to that in a study performed in Pakistan [ 17 ], in which the prevalence was 89.3%. Furthermore, these findings are consistent with those of a study from India [ 19 ], which reported incidences of 62%, 22.2% and 15.6% for massive, moderate and mild, respectively. The difference in moderate and mild symptoms may be due to the duration of symptoms among the study participants, and the sample size could be the reason since our sample size was larger than that of their study participants.

Of the 251 confirmed CML patients, approximately 86.1% were confirmed by FISH and were Ph+ (t (9; 22) positive). Approximately 9.2% and 4.8% of the patients were confirmed by the Xpert BCR-ABL Ultra test and PCR, respectively, which indicated that these patients were BCR::ABL1  or p210-positive. These molecular testing methods were also used in other studies; for example, Ngono AP et al. , from Cameroon, used (22.7%) FISH and (4.5%) RT‒PCR and detected the presence of the t(9; 22) or BCR::ABL1 transcript in all patients [ 1 ]. According to the CML data obtained by both quantitative and qualitative PCR, all the detected transcripts were of major breakpoint proteins, and p210 is encoded by the e13a2/e14a2 isoform. The presence of the BCR::ABL1 transcript as a result of reciprocal translocation between chromosomes 9 and 22 is well known in CML. In more than 95% of CML patients, the typical BCR::ABL1 transcript subtypes are e13a2 (b2a2), e14a2 (b3a2), or the simultaneous expression of both) [ 24 , 25 ].

In our case, qualitative PCR was performed for FISH negative patients; accordingly, six patients who were FISH negative were P210-positive according to qualitative PCR. Qualitative PCR is appropriate for the initial diagnosis of CML, and it can detect the presence of the p210, p190 and p230 transcripts. Thus, although there is an unaffordability of different advanced molecular techniques among suspected CML patients, using these different molecular techniques is important for providing accurate diagnosis and early detection and for monitoring CML patients.

Strengths and limitations

This study included relatively large sample sizes and was conducted at the only CML clinic in the country; thus, it could represent the country of interest, Ethiopia. Since this was the first study conducted on this topic, it provides current information on the hematological, clinical, cytogenetic and molecular profiles of newly diagnosed CML patients. As a limitation, further testing was not performed, as was clinical chemistry. In addition, for every patient, cytogenetic and molecular analyses were not performed due to the unavailability and unaffordability of these tests since they were performed abroad.

During presentation, most of the CML patients had hyperleukocytosis, neutrophilia or anemia at TASH, Addis Ababa, Ethiopia. Patients in younger age groups with a median age of 36 years and more than 91% ≤ 60 years were affected by CML in Ethiopia. Approximately 85% of the CML patients had CP-CML, whereas more than 42.6% of the patients had abnormal platelet counts. Fatigue, abdominal pain, splenomegaly and weight loss were the most common signs and symptoms observed in the CML patients. Most of the study participants were Ph + according to FISH analysis, and the major breakpoint protein p210, which is encoded by the e13a2/e14a2 transcript, was detected in all patients diagnosed by both quantitative and qualitative PCR.

Most of the patients come from distant areas; as a result, they arrive after advanced stages with different signs and symptoms, thus better to decentralize the service to peripheral health facilities. In addition, a locally established reference range for hematological and clinical parameters should be established considering age, sex, geographical location and other variables, as well as access to advanced laboratory facilities for early detection and monitoring of cytogenetic and molecular parameters of CML patients.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due [we do not have consent from all patients and ethical approval committees to publish this data] but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge Addis Ababa University for giving us the chance to conduct the study through thematic research. In addition, we would like to extend our respect and acknowledgment to the study participants and CML clinic staff members especially for Sr Birhane Gebre, Yemeserach Dessie and Mr Lenjisa Kumsa for helping us during data collection period.

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Authors and affiliations.

Medical Laboratory Sciences Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

Fekadu Urgessa, Boki Lengiso & Aster Tsegaye

Internal Medicine Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

Amha Gebremedhin, Fozia Abdella & Fisihatsion Tadesse

Cellular and Molecular Biology Department, College of Natural and Computational Sciences, Addis Ababa University, Addis, Ababa, Ethiopia

Fekadu Urgessa, Helen Nigussie & Teklu Kuru Gerbaba

Fred Hutchison Cancer Center, Seattle, WA, USA

Jerald Radich

Microbix Biosystems Inc, Mississauga, ON, Canada

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Ethiopian Public Health Institute, Addis Ababa, Ethiopia

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Contributions

FU and BL conducted the literature search, collected and analyzed the data, and wrote the manuscript. FU and BL were also participated in the writing, analysis and data interpretation, in addition to providing critical input to the research. All authors conceptualized and designed the study. AT, AG, FA, FT, TR, HN and TKG supervised the data collection, participated in data analysis, contributed to the discussion, reviewed and edited the manuscript, and provided critical data interpretation. All authors read and accepted the final manuscript.

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Correspondence to Fekadu Urgessa .

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Ethics approval and consent to participate.

The study was approved by the Department of Medical Laboratory Sciences, College of Health Science, AAU ethical committee, and permission was granted from the Department of Internal Medicine, TASH, AAU. Written informed consent was obtained from the patients, care givers or parents. The confidentiality of the participant data was linked to the study code number, and the data were kept private. Any abnormal test results of the study participants were communicated to their attending physician.

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Competing interest.

We, the authors declare that there is no conflict of interest.

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Urgessa, F., Lengiso, B., Tsegaye, A. et al. Hematological, clinical, cytogenetic and molecular profiles of confirmed chronic myeloid leukemia patients at presentation at a tertiary care teaching hospital in Addis Ababa, Ethiopia: a cross-sectional study. BMC Cancer 24 , 530 (2024). https://doi.org/10.1186/s12885-024-12282-x

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Received : 23 January 2024

Accepted : 17 April 2024

Published : 26 April 2024

DOI : https://doi.org/10.1186/s12885-024-12282-x

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