Myelophthisic Anemia Differential Diagnoses

  • Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
 
Updated: Nov 26, 2015
 
 

Diagnostic Considerations

The leukoerythroblastic picture, the characteristic laboratory changes associated with myelophthisic anemia, is characterized by the following findings in the peripheral blood smear:

  1. Nucleated red blood cells and teardrop forms
  2. Giant platelets
  3. Immature white blood cells (eg, myelocytes, metamyelocytes, occasionally promyelocytes and myeloblasts) 

See the image below.

This blood film at 1000X magnification demonstrate This blood film at 1000X magnification demonstrates a leukoerythroblastic blood picture with the presence of precursor cells of the myeloid and erythroid lineage. In addition, anisocytosis, poikilocytosis, and polychromasia can be seen. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.

The differential diagnosis to separate myelophthisic process secondary from a primary myeloproliferative syndrome that is a clonal stem cell disorder resulting in myelofibrosis due to excessive proliferation of one or more cell lineages is performing a cytogenetic evaluation of the bone marrow cells. However, this test can only be successfully performed if dividing cells can be obtained from the bone marrow aspiration for classic cytogenetic testing. Fluorescent in situ hybridization (FISH) can be performed in nondividing cells but is limited to a panel of set abnormalities. Secondary myelofibrosis due to a myelophthisic process should have normal cytogenetics. The frequency of a "dry" bone marrow aspiration owing to fibrosis of the marrow limits the performance of this test.

Using immunomorphometric methods by immunostaining for CD34 to differentiate primary from secondary myelofibrosis has not been successful.[7]

The 2010 World Health Organization (WHO) classification of diagnostic criteria, which updated the 2008 classification, defines strict criteria for the primary diseases.[8, 9] Using the JAK2V617F mutation could be more helpful, but unfortunately only half of the primary myeloproliferative diseases of concern are positive.[10]

Go to Anemia, Chronic Anemia, Megaloblastic Anemia, Myelophthisic Anemia, Hemolytic Anemia, and Sideroblastic Anemias for complete information on these topics.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Koyamangalath Krishnan, MD, FRCP, FACP Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine, 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 Hematology, Royal College of Physicians

Disclosure: Nothing to disclose.

References
  1. Pham CM, Syed AA, Siddiqui HA, Keller RA, Kowalewski C. Case of metastatic basal cell carcinoma to bone marrow, resulting in myelophthisic anemia. Am J Dermatopathol. 2013 Apr. 35 (2):e34-6. [Medline].

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

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

  4. Makoni SN, Laber DA. Clinical spectrum of myelophthisis in cancer patients. Am J Hematol. 2004 May. 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). 1983 Nov. 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. 1993 Jun 1. 71(11):3594-600. [Medline].

  7. Sharma P, Pati HP, Mishra PC, et al. Inability of immunomorphometric assessment of angiogenesis to distinguish primary versus secondary myelofibrosis. Anal Quant Cytol Histol. 2011 Aug. 33(4):236-44. [Medline].

  8. Vardiman JW. The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues: an overview with emphasis on the myeloid neoplasms. Chem Biol Interact. 2010 Mar 19. 184 (1-2):16-20. [Medline].

  9. Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009 Jul 30. 114(5):937-51. [Medline].

  10. Bellanné-Chantelot C, Chaumarel I, Labopin M, et al. Genetic and clinical implications of the Val617Phe JAK2 mutation in 72 families with myeloproliferative disorders. Blood. 2006 Jul 1. 108(1):346-52. [Medline].

 
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This blood film at 1000X magnification demonstrates a leukoerythroblastic blood picture with the presence of precursor cells of the myeloid and erythroid lineage. In addition, anisocytosis, poikilocytosis, and polychromasia can be seen. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
This bone marrow film at 400X magnification demonstrates carcinoma metastasis. Bone marrow cells are completely replaced by large carcinoma cells with clear nucleoli. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
 
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