Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Myelophthisic Anemia Workup

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

Approach Considerations

The presence of lytic and blastic lesions on skeletal radiographic films is common in patients with prostate, lung, or breast cancer metastases.

Bone scans are sensitive for detecting abnormalities found in myelophthisic anemia and for detecting bone metastases, while magnetic resonance imaging (MRI) scans of the involved area can detect marrow infiltration.

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.

In miliary tuberculosis, caseating granulomas demonstrate positive acid-fast organisms. Tuberculosis granulomas also reveal typical Langhans-type giant cells with multiple nuclei.

Next

Leukoerythroblastic Picture

The characteristic laboratory changes associated with myelophthisic anemia are referred to as a leukoerythroblastic picture, and they include the following (see the image below):

  • 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
    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.
Previous
Next

Histologic Findings

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

This bone marrow film at 400X magnification demons 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.
Previous
 
 
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].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.