To the Editor,. Leukoerythroblastosis due to infections can resemble leukemia, differential diagnosis can be difficult. Bone marrow examination is essential for. that leukoerythroblastosis is most frequently seen in the adult leukoerythroblastosis in infection and blood loss. . produce changes in the white cell picture or. Peripheral blood film demonstrating a leukoerythroblastic picture; that is, the presence of nucleated red blood cells and immature granulocyte precursors.

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Now we will look at increases in white cell number above the normal range for age and sex. An increase in the WBC count leukocytosis is a typical response to noxious stimuli and is usually part of an inflammatory reaction. A leukocytosis is frequently accompanied by cytologic abnormalities, such as toxic granulation or Dohle bodies discussed later in this section.

Although all or individual types of leukocytes neutrophils, lymphocytes, etc. Neutrophilia may be due to a number of acute and picrure causes: In response to licture or other stimuli, neutrophils move from the marginating or storage pool into the circulating peripheral blood.

Next bone marow reserves are shifted into the peripheral blood and finally marrow production is increased. Immature neutrophils bands, metamyelocytes, myelocytes, and occasionally promyelocytes are released into the peripheral blood. This premature release of not yet fully mature neutrophils is called a myeloid “left shift”. Normal mature neutrophils contain small amounts of leukocyte alkaline phosphatase LAP in primary granules.

The peripheral blood LAP is elevated during leukocytosis because of the “left shift”. Pseudoneutrophilia may result in response to acute stress exercise, epinephrine,anesthesia, etc. There is leukoerythdoblastic increase in the total number of neutrophils, only a shift from the marginal storage pool to the circulating blood. Asplenia can result in a moderate leukocytosis as the normal spleen holds a large part of the marginating pool of leukocytes.

Corticosteroids may stimulate the release of neutrophils from the marrow and slow or prevent the egress of neutrophils from the circulation.


Three conditions related to leukocytosis are leukostasis, and leukemoid and leukoerythroblastic reactions.

Leukostasis results from sludging of high numbers of leukocytes in small vessels, particularly the brain, lungs, and kidneys.

Death may occur due to impaired blood flow or enormous metabolic requirements of large numbers of leukocytes. This may be due to the large size of the myeloid blasts compared to CLL cells or may relate to different expression of intercellular adhesion molecules.

Leukemoid reactions are characterized by blasts, promyelocytes, myelocytes, and metamyelocytes in the peripheral blood. A leukoerythroblastic reaction is similar to a leukomoid reaction leujoerythroblastic the addition of nucleated red blood cells.

A leukowrythroblastic picture indicates severe disruption of the marrow and is common in myelofibrosis primary or secondary.

Leukoerythroblastic reactions suggest possible extramedullary hemtopoiesis and is often secondary to metastatic cancer. In infants a leukoerythroblastic reaction suggests severe hemolytic anemia, such as erythroblastosis fetalis shown below. Another disease, osteopetrosis is a rare childhood disorder of bone in which abnormal osteoclasts are unable to resorb bone.

Thus bone unable to be remodelled, replaces hematopoietic marrow space, leading to extramedullary hematopoiesis and spillage of hematopoietic elements into the peripheral blood.

In addition to neutrophilia one may encounter specific increases in the number of lymphocytes, leukoerhthroblastic, basophils, and monocytes in the peripheral blood. One must always consider the absolute lymphocyte count to determine leumoerythroblastic a lymphocytosis is present.

Lymphocytoses occur most frequently during viral infections and only rarely in bacterial infection except pertussis. Pertussis or whooping cough is frequently accompanied by a lymphocytosis usually Toxoplasmosis leukoerythroblasic cause an lymphocytosis similar to infectious mononucleosis with atypical lymphocytes, fever, and lymphadenopathy.

The chronic infections brucellosis and syphilis may occassionally cause an atypical lymphocytosis. Infectious mononucleosis – The disease pitcure generally self limited and is caused by an Epstein-Barr virus infection of B lymphocytes.

Leukoerythroblastosis in the Adult | American Journal of Clinical Pathology | Oxford Academic

The atypical lymphocytes are large and reactive with abundant basophilic cytoplasm. Some may appear almost blast-like. These changes are not unique to IM, but can be seen in other viral infections. Infectious mononucleosis is most common in adolescents and young adults. Patients present with fever, sore throat, and lymphadenopathy often cervical. CMV occassionally causes a leukoerythroblaatic with symptoms similar to IM and may follow pciture transfusions. Other viral causes of lymphocytosis include infectious lymphocytosis and HTLV-1 related transient lymphocytosis.


Pathology Thread

Infectious lymphocytosis is characterized lsukoerythroblastic a lymphocytosis of small lymphocytes, generally This is mainly a disease of children and is benign. It may be related to coxsackievirus A or B6, echovirus, and adenovirus There is almost never splenomegaly or lymphadenopathy. Most patients recover; however, some develop adult T cell leukemia.

Monocytosis may result from viral, fungal, rickettsial, and protozoal infections. Phagocytosis of erythrocytes, leukocytes, and platelets by monocytes and histiocytes is seen in the ” hemophagocytic syndrome ” which is associated with viral or bacterial infections and T cell malignant lymphoma.

When large numbers of eosinophils are present the crytalloid material may form Charot-Leyden crystals. Increased basophils are associated with polycythemia vera and extramedullary hematopoiesis.

Basophilia is also reported in hypothyroidism. Leukocytosis Benign White Cell Disorders: Leukocytosis Now we will look at increases leuloerythroblastic white cell number above the leukoerythrlblastic range for age and sex.

Minor causes of leukocytosis include: Leukemoid picturw may be secondary to benign or malignant conditions. The WBC count is often in a range of Other forms of leukocytosis: MBP major basic protein released from the eosinophilic granules coats the Schistosoma organism prior to antibody-complement independent killing.

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Some of our pages are restricted to UVa School of Medicine users and require an Oasis account for access. Benign White Cell Disorders: