Inspect the following full blood count:

Parameter

Patient Value

Normal Adult Range

Haemoqlobin

96 q/L*

130 - 175

White Cell Count

17.4 x 10 /L*

4.0 - 11.0

Platelets

168 x 109/L

150 - 450

Neutrophils

12.4 x 10 /L*

1.8 - 7.5

Lymphocytes

2.06 x 10 /L

1.50 - 4.00

Monocytes

0.5 x 10 /L

0.2 - 0.8

Eosinophils

0.3 x 10/L

0.0 - 0.4

Film: Circulating nucleated red blood cells, immature granulocytes and band forms observed.

a)    What is the term used to describe these findings on a blood film?    (20% marks)

b)    Give four possible reasons these findings may be observed in a critically ill patient.
(20% marks)

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College answer

  1. Leucoerythroblastic anaemia/reaction                                                                  
  1.  
  • Sepsis
  • Trauma
  • Any marrow infiltrative process, carcinomas, myeloproliferative disorders
  • Rebound following bone marrow failure or suppression      

Discussion

The key findings are anaemia, nucleated red cells, immature granulocytes and band forms.

These abnormalities can be described as a  "leukoerythroblastic" blood film picture

In summary, the possible causes of leukoerythroblastosis are:

  • Bone marrow inflitration ("myelophthisis")
    • Leukaemia
    • Myelofibrosis
    • Solid tumour infiltration, eg. breast cancer
    • Miliary tuberculosis
  • Extramedullary haematopoiesis
  • States of widespread bone marrow activation
    • Sepsis
    • Inflammatory states, eg. autoimmune disease
    • Severe haemorrhage or haemolysis
    • Use of GM-CSF
    • Marrow recovery following marrow suppression
  • Exotic stuff
    • Still disease
    • Gaucher's disease
    • Myocardial infarction
    • Chronic lung diseases

References

References

Shamdas, Glenn J., et al. "Leukoerythroblastic anemia in metastatic prostate cancer. Clinical and prognostic significance in patients with hormone‐refractory disease." Cancer 71.11 (1993): 3594-3600.

Weick, J. K., A. B. Hagedorn, and J. W. Linman. "Leukoerythroblastosis. Diagnostic and prognostic significance." Mayo Clinic Proceedings. Vol. 49. No. 2. 1974.