Presentation
History and Physical Examination
Focus the history and physical examination on establishing the underlying disease, such as an advanced carcinoma, lymphoma, or granulomatous disease. Family history is important for eliciting information in congenital and inherited forms of the disease.
Physical findings usually reflect the underlying medical condition, such as metastatic carcinoma, lymphoma, or tuberculosis. Anemia may cause skin pallor. Severe thrombocytopenia may produce petechiae or ecchymoses. Patients with severe neutropenia may become infected and present with fever.
Patients with myelophthisic anemia secondary to cobalamin deficiency may also present with leukoerythroblastosis, a hemolytic picture, and splenomegaly. [8]
Media Gallery
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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 Ulrich Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
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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 Ulrich Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
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