eMedicine Specialties > Hematology > Red Blood Cells and Disorders

Myelophthisic Anemia: Differential Diagnoses & Workup

Author: Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Coauthor(s): Ulrich Woermann, MD, Consulting Staff, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland
Contributor Information and Disclosures

Updated: Jan 4, 2008

Differential Diagnoses

Agnogenic Myeloid Metaplasia With Myelofibrosis
Lung Cancer, Oat Cell (Small Cell)
Breast Cancer
Prostate Cancer: Metastatic and Advanced Disease
Gaucher Disease
Sarcoidosis
Lung Cancer, Non-Small Cell
Tuberculosis

Workup

Laboratory Studies

  • The characteristic laboratory changes associated with myelophthisic anemia are referred to as a leukoerythroblastic picture, and they include the following:
    • Nucleated red blood cells and teardrop forms
    • Giant platelets
    • Immature white blood cells (eg, myelocytes, metamyelocytes, occasionally promyelocytes and myeloblasts) in the peripheral blood smear
  • In miliary tuberculosis, caseating granulomas demonstrate positive acid-fast organisms. Tuberculosis granulomas also reveal typical Langhans-type giant cells with multiple nuclei.
  • Infiltration by cells with "onion-peel" cytoplasm, called Gaucher cells, is caused by a lipid storage disorder (ie, glucosyl ceramide lipidosis).
    • Gaucher cells clog or infiltrate the bone marrow, spleen, and liver.
    • This disorder is inherited. Obtaining family history is very important.

Imaging Studies

  • The presence of lytic and blastic lesions on skeletal x-ray films is common in patients with prostate, lung, or breast cancer metastases.
  • Bone scans are sensitive for detecting these abnormalities and for the presence of bone metastases.
  • MRIs of the involved area can detect marrow infiltration.

Procedures

  • The bone marrow aspirate is usually a dry tap because myelofibrosis makes aspirating blood from the marrow cavity difficult.
    • Biopsy results usually reveal the underlying infiltrative process.
    • Clusters or islands of large anaplastic cancer cells that bear characteristics of their primary tumor are often observed.
    • Malignant lymphomas invade bone marrow and can cause a myelophthisic myelopathy.

Histologic Findings

Immature cells are present in the peripheral blood because the blood-marrow barrier is disrupted. This causes early release of immature cells into the circulation, referred to as leukoerythroblastic anemia. Changes in the bone marrow are caused by replacement of normal marrow cells with abnormal nonhematopoietic cells, such as cells tainted by cancer, lymphoma, or infectious agents. This results in fibrosis or scarring of the marrow cavity.

More on Myelophthisic Anemia

Overview: Myelophthisic Anemia
Differential Diagnoses & Workup: Myelophthisic Anemia
Treatment & Medication: Myelophthisic Anemia
Follow-up: Myelophthisic Anemia
Multimedia: Myelophthisic Anemia
References
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References

  1. Delsol G, Guiu-Godfrin B, Guiu M, Pris J, Corberand J, Fabre J. Leukoerythroblastosis and cancer frequency, prognosis, and physiopathologic significance. Cancer. Sep 1979;44(3):1009-13. [Medline].

  2. Weick JK, Hagedorn AB, Linman JW. Leukoerythroblastosis. Diagnostic and prognostic significance. Mayo Clin Proc. Feb 1974;49(2):110-3. [Medline].

  3. Brochamer WL Jr, Keeling MM. The bone marrow biopsy, osteoscan, and peripheral blood in non-hematopoietic cancer. Cancer. Aug 1977;40(2):836-40. [Medline].

  4. Makoni SN, Laber DA. Clinical spectrum of myelophthisis in cancer patients. Am J Hematol. May 2004;76(1):92-3. [Medline].

  5. Bodem CR, Hamory BH, Taylor HM, Kleopfer L. Granulomatous bone marrow disease. A review of the literature and clinicopathologic analysis of 58 cases. Medicine (Baltimore). Nov 1983;62(6):372-83. [Medline].

  6. Shamdas GJ, Ahmann FR, Matzner MB, Ritchie JM. Leukoerythroblastic anemia in metastatic prostate cancer. Clinical and prognostic significance in patients with hormone-refractory disease. Cancer. Jun 1 1993;71(11):3594-600. [Medline].

  7. Jandl JH. Blood. In: Pathophysiology. Oxford, England: Blackwell Scientific; 1991:104-5.

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Further Reading

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Keywords

myelophthisis, secondary myelofibrosis, marrow infiltration, marrow granuloma, infiltrative myelopathy, nonhematopoietic cells, cytopenia, thrombocytopenia, neutropenia, pancytopenia, anemia, metastatic carcinomas, metastatic cancer, lung cancer, breast cancer, prostate cancer, lymphoproliferative malignancies, lymphoproliferative cancers, lymphomas, disseminated granulomatous diseases, miliary tuberculosis, Gaucher disease

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Contributor Information and Disclosures

Author

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Coauthor(s)

Ulrich Woermann, MD, Consulting Staff, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland
Disclosure: Nothing to disclose.

Medical Editor

Koyamangalath Krishnan, MD, FRCP, FACP, Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Clinical Oncology, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Koyamangalath Krishnan, MD, FRCP, FACP, Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Clinical Oncology, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

 
 
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