46 Anemia associated with Marrow Infiltration

Question 1

Refers to anemia resulting from the presence of spotty to massive marrow infiltration with abnormal cells or tissue components

Best reserved for marrow replacement by nonhematologic tumors and nonhematopoietic entities

Answer 1

Myelophthisic anemia

Question 2

Referred to as findings accompanied by teardrop-shaped red cells (dacrocytes), nucleated red cells, and immature myeloid cells

Answer 2

Leukoerythroblastic reaction

Question 3

Invasion is the primary process of metastasis and occurs often as a result of loss of ________

Answer 3

E-cadherin

Question 4

Non-hematopoeitic crystals that can cause marrow infiltration

Answer 4

Calcium oxalate

Question 5

Most common cancers that metastasize to the marrow

Answer 5

Cancers of the lung, breast, and prostate

BLP

Overt leukoerythroblastic blood picture is less common, and its absence is not a reliable indicator that the marrow is not involved.

Question 6

Morphologic picture consists of cell debris and occasional necrotic cells in an eosinophilic amorphus background

Answer 6

Marrow necrosis

Question 7

Most common underlying cause of marrow necrosis

Answer 7

Metastatic tumors, acute lymphoblastic leukemia (children), and septicemia

Others: fat embolism syndrome in sickle cell disease and associated parvovirus B19 infection and arsenic therapy in acute promyelocytic leukemia

Question 8

The most characteristic blood feature of Myelophthisic anemia

Answer 8

Disturbed morphologic appearance of red cells on the blood film

The presence of teardrop forms and nucleated red cells is particularly suggestive of marrow infiltration

Question 9

The most reliable procedure used to diagnose marrow-infiltrative disease and should be performed in all patients with suspected metastatic carcinoma or hematologic features of myelophthisic anemia.

Answer 9

Marrow biopsy

Because the diagnostic marrow yield from biopsies depends on the amount of tissue examined,bilateral posterior iliac crest marrow biopsies may be necessary.

Question 10

Reliably identifies marrow infiltration by Gaucher cells

Answer 10

Technetium-99m (99mTc) sestamibi uptake

Question 11

Helpful for defining the severity of marrow replacement and is being used with increasing frequency

Answer 11

Magnetic resonance imaging (MRI)

Question 12

MRI findings in marrow necrosis

Answer 12

Extensive, diffuse, geographic pattern of signal abnormality consisting of a central area of variable signal intensity surrounded by a distinct peripheral enhancing rim

Question 13

The goal of treatment in Myelophthisic anemia

Answer 13

Manage the underlying disease