An interesting blood film from a patient with primary myelofibrosis with the typical features of leucoerythroblastosis.

Note the rainbow of cells (and arrows ):

  • GREEN – blast cell
  • RED – tear drop poikilocyte or dacrocyte
  • BLUE – large platelet/megakaryocyte fragment
  • YELLOW – myelocyte i.e. left shifted granulocyte
  • BROWN – nucleated red cell

Patients with this condition may undergo splenectomy for symptomatic relief of abdominal pain. As well seeing features of asplenism (Howell-Jolly bodies, acanthocytes, target cells) the tear drop poikilocytes often disappear!

Here the number of tear drop cells and large platelets suggests myelofibrosis is the diagnosis. Be careful however as this leucoeryhtroblastic picture should make you think of other infiltrative processes in the bone marrow.


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