hematology and oncology
Myelophthisic Anemia
Diagnosis of Myelophthisic Anemia
Complete blood count (CBC), red blood cell (RBC) indices, reticulocyte count, and peripheral smear Bone marrow examination Myelophthisic anemia is suspected in patients with normocytic anemia, particularly when splenomegaly or a potential underlying cancer is present. If it is suspected, a Peripheral smear should be done, because a leukoerythroblastic pattern (immature myeloid and erythroid cells such as myelocytes and metamyelocytes, and normoblasts or other nucleated RBCs) suggests myelophthisic anemia. Extramedullary hematopoiesis or disruption of the marrow sinusoids causes release of immature myeloid cells and nucleated red cells into the periphery. Abnormally shaped RBCs, typically teardrop-shaped (dacrocytes), are also present. Anemia, usually moderate to severe, is characteristically normocytic but may be slightly macrocytic. RBC morphology may show extreme variation (anisocytosis and poikilocytosis) in size and shape. The white blood cell count may vary. The platelet count is often low, and platelets are often large and bizarre in shape. Although examination of peripheral blood can be suggestive, diagnosis usually requires Bone marrow aspiration and biopsy . Indications include a leukoerythroblastic pattern and unexplained splenomegaly. The marrow may be difficult to aspirate; marrow trephine biopsy is usually required. Findings vary according to the underlying disorder. Erythropoiesis is normal or increased in some cases. Hematopoiesis may be present in the spleen and liver. X-rays, if obtained incidentally, may disclose bony lesions (myelosclerosis) characteristic of long-standing myelofibrosis or other osseous changes (ie, osteoblastic or lytic lesions of a tumor), suggesting the cause of anemia. 