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Transient erythroblastopenia of childhood (TEC) presenting as leukoerythroblastic anemia.

PURPOSE: The diagnosis of transient erythroblastopenia of childhood (TEC) is usually straightforward, with temporary cessation of red blood cell production resulting in normocytic normochromic anemia, reticulocytopenia, and bone marrow erythroblastopenia. We describe here a case of TEC presenting with features of leukoerythroblastic anemia. To our knowledge, this is the first such report for TEC. PATIENT AND METHODS: The case of a 1-year-old girl is described who had a leukoerythroblastic anemia. Bone marrow examination and clinical course indicated that the anemia had a benign etiology-TEC. RESULTS: The patient presented with anemia, leukocytosis, and a left shift, with metamyelocytes, myelocytes, myeloblasts, and nucleated red cells in the circulation. There was no apparent viral etiology, and the bone marrow aspirate findings were consistent with a recovering marrow. After transfusion, the patient had an uneventful recovery from TEC. CONCLUSION: TEC can cause leukoerythroblastic anemia. TEC with this presentation is clinically similar to TEC without leukoerythroblastosis, but other causes of leukoerythroblastosis need to be excluded.

Anemia↗

Leukoerythroblastic anemia in metastatic prostate cancer. Clinical and prognostic significance in patients with hormone-refractory disease.

BACKGROUND: The clinical and prognostic significance of leukoerythroblastic anemia (LKEA) in patients with metastatic prostate cancer and, in general, patients with disseminated solid tumors is poorly understood. Therefore, the authors studied a population of patients with metastatic prostate cancer refractory to hormonal therapy to assess the incidence, clinical features, and prognostic implications of LKEA. METHODS: The medical records of 106 patients with hormone-refractory prostate cancer metastatic to bone seen at the Tucson Veterans Affairs Medical Center between 1985 and 1991 were reviewed retrospectively. The clinical and laboratory data, number of packed erythrocyte transfusions required, and length of survival from the time of diagnosis of hormone-refractory disease until last follow-up visit or death were investigated in 91 identified patients. RESULTS: Twenty-six of 91 patients (28.6%) were found to have LKEA. LKEA developed before or at the time of diagnosis of hormone-refractory disease in 8 patients and after diagnosis of hormone-refractory disease in 18 patients. The presence of LKEA was associated with significantly lower hemoglobin levels and platelet (Plt) counts and significantly higher total bilirubin, lactic dehydrogenase (LDH), and alkaline phosphatase values (P < 0.05). Leukopenia (< 4.0 x 10(9)/l leukocytes), thrombocytopenia (< 150 x 10(9)/l Plt), elevated LDH levels (> 220 U/l), and laboratory evidence of disseminated intravascular coagulation (DIC) were more common in patients with LKEA than in those without LKEA (P < 0.01). Microangiopathic hemolysis was seen in only 2 of 91 patients (2.1%). Patients with LKEA had significantly greater transfusion requirements compared with patients without LKEA (P < 0.0001), but the median survival length was not significantly different (9 months versus 11 months, respectively). The presence of DIC and LDH levels of 500 U/l or greater in patients with LKEA was associated with a poor prognosis. CONCLUSIONS: LKEA is a relatively common finding in patients with hormone-refractory metastatic prostate cancer and is associated with greater transfusion requirements. Its presence, however, does not affect survival significantly.

Aged↗

[Severe hemorrhage, lymphocytosis and leukoerythroblastic blood picture--disseminated intravascular coagulation in metastatic prostate carcinoma and chronic lymphatic leukemia].

Hemorrhagic complications in CLL are most often related to thrombocytopenia either due to decreased megakaryopoiesis caused by diffuse lymphocytic bone marrow infiltration or to increased peripheral platelet consumption by platelet autoantibodies (immune thrombocytopenia), both being typical manifestations of the disease. Disseminated intravascular coagulation (DIC) does not belong to the spectrum of CLL-related complications. In the case here reported with DIC and newly diagnosed CLL the leukoerythroblastic blood changes hinted to bone marrow infiltration by another neoplastic process in addition to CLL. Bone marrow biopsy revealed infiltration by metastatic carcinoma of the prostate in addition to that by CLL, the former being responsible for triggering severe DIC leading to fatal intracranial bleeding.

Aged↗

Spider bite hemolytic anemia: positive Coombs' test, erythrophagocytosis, and leukoerythroblastic smear.

The full hematologic profile of spider bite hemolytic anemia has not been documented in the literature. The two patients had brisk intravascular hemolysis with direct Coombs' tests positive for complement and with peripheral blood smears showing spherocytosis, erythrophagocytosis, and leukoerythroblastosis. The author's experience, along with that in the literature reviewed herein, suggests that the hemolytic anemia that can follow the bite of the brown recluse spider could be confused with autoimmune hemolytic anemia.

Adult↗