Systematic review about etiologic association to the leukoerythroblastic reaction

Abstract

Background and purpose Leukoerythroblastic reaction (LER) is characterized by the presence of immature erythroid cells and myeloid precursors (metamyelocytes, myelocytes, promyelocytes, myeloblasts, and blasts) as well as, exclusively in myelofibrotic disorders, teardrop cells in the peripheral blood (J Pathol Bacteriol, 42, 1936, 541; Semaine Med, 22, 1902, 373). Research on how to interpret LER and its meaning in clinical practice is scarce, and there is no consensus on the diagnostic criteria. We summarize the current evidence with the aim of clarifying the knowledge on this subject. Methods We conducted a comprehensive search of the PubMed‐MEDLINE, EMBASE and ELSEVIER databases, the Cochrane Library, Google Scholar, and medical journals to identify relevant papers. Results Our search identified 425 papers, of which, 35 (11 trials and 24 case reports) ultimately met the inclusion criteria. These showed two principal groups of diseases associated with leukoerythroblastosis (LEB), corresponding to solid and hematological malignancies. The other etiologies, in order of frequency, were hemolytic diseases, infection, and others, while hemorrhage was only reported in the trials group. Conclusion The literature on LER is scarce and heterogeneous. The etiological factors of LER are diverse, and its presence in malignant disease is an indicator of disease progression and an adverse prognosis suggesting poor survival. In those cases where LER had neither hematological nor solid neoplasms, its manifestation, prognosis and its impact on our daily clinical practice are unknown.

Improving the efficiency of the autoverification workflow for nucleated red blood cell reporting in the hematology laboratory

“…The presence of NRBC in peripheral blood is an important finding, indicating not only pathologic conditions but also patient prognostication 3‐11 . The manual count has been the standard method for detection and enumeration of circulating NRBCs, adopted by most hematology laboratories.…”

“…In contrast, the presence of such cells in peripheral blood of older children and adults signifies a pathological state of the bone marrow. Possible causes include hematopoietic stress, bone marrow damage, massive hemorrhage, and severe hypoxia, which usually lead to hematology consultation and, in some cases, invasive investigation like bone marrow examination 3‐7 …”

Is a leukoerythroblastic blood picture common in COVID-19-positive adults?

“…It is defined as a condition in which there is a presence of immature myeloid cells and nucleated red blood cells in the circulating blood [4]. LER is most commonly seen in patients with metastatic malignancies, but Clifford was the first to describe it in conditions other than cancer, including hemolytic anemia, blood loss (acute or chronic), congestive heart failure, sepsis, megaloblastic anemia, and tuberculosis [5][6][7]. LER is usually not seen in viral infections, except for one study by Lemont et al in 2011 that showed LER can rarely be seen in parvovirus B19 infection [8].…”

Reacción leucoeritroblástica. Presentación poco frecuente de leucemia aguda en niños.

“…El síndrome leucoeritroblástico puede aparecer en diferentes enfermedades neoplásicas (1,2) , infecciosas (Parvovirus B19 (3) , malaria grave (4) ), mielofibrosis, anemias hemolíticas o hemorragia grave. Es muy poco frecuente en la población pediátrica, limitado de forma casi exclusiva a procesos infecciosos (5) .…”