A Study of Bone Marrow Aspiration and Biopsy in Adult Patients Presenting with Leukoerythroblastic Blood Picture

  • Shubha H V Sapthagiri Institute of Medical Sciences and Research Centre, Chikkasandra, Bangalore, Karnataka, India
  • Nirmala C Bangalore Medical College and Research Institute (BMCRI), Bangalore, Karnataka, India
  • Dayananda S Biligi Bangalore Medical College and Research Institute (BMCRI), Bangalore, Karnataka, India
Keywords: Bone marrow aspiration, Bone marrow biopsy, Leukoerythroblastosis, Myelodysplastic syndrome, Myelofibrosis


Introduction: The presence of leukoerythroblastosis serves as a valuable clue to the presence of some underlying serious disease. Various infiltrating & non-infiltrating conditions present as leukoerythroblastic picture ranging from infections, sepsis, haemorrhage, haemolysis, anemias to leukemias, lymphomas & metastases. Aims and objectives: To confirm the diagnosis of various conditions presenting with leukoerythroblastosis by studying the bone marrow morphology and to study the distribution of various conditions presenting with leukoerythroblastosis in different age groups and sex. Materials and methods: A total of 50 adult patients presenting with leukoerythroblastosis were studied during the period from October 2014 to August 2016. The bone marrow aspiration and biopsy were preceded by the evaluation of patient’s medical history, clinical and hematological findings with peripheral smear examination for the presence of leukoeythroblastosis. The findings were documented on a proforma. Results:  13 (26%) cases were in the age group of   21-30 years which constituted the largest group. 26 (52%) were males and 24 (48%) were females. The spectrum of conditions presenting with leukoerythroblastosis were non–infiltrating conditions with one (2%) normal study, 8 (16%) erythroid hyperplasias, 21 (42%) megaloblastic anemias, 5 (10%) myelodysplastic syndromes and 1 (2%) hypoplastic marrow and among the infiltrating conditions were 2 (4%) acute myeloid leukemias, 6 (12%) myeloproliferative disorders, 1 (2%) metastatic deposit, 2 (4%) lymphoproliferative disorders and 3 (6%) multiple myelomas. Conclusion: Leukoerythroblastosis indicates the extent to which bone marrow reacts to stress and disease. It is characteristic & diagnostic of a disordered marrow function. Thus, bone marrow aspiration and biopsy help in establishing an early diagnosis and better prognosis of the disease can be expected.

Author Biographies

Shubha H V, Sapthagiri Institute of Medical Sciences and Research Centre, Chikkasandra, Bangalore, Karnataka, India
Department of Pathology
Nirmala C, Bangalore Medical College and Research Institute (BMCRI), Bangalore, Karnataka, India
Department Of Pathology
Dayananda S Biligi, Bangalore Medical College and Research Institute (BMCRI), Bangalore, Karnataka, India
Professor and Head of the Department Department of Pathology


1. Vaughn JM. Leuco-erythroblastic anaemia. J Pathol Bacteriol 1936;42:541-64.
2. Burkett LL, Cox ML, Fields ML. Leukoeryhtroblastosis in the adult. Am J Clin Pathol 1965;44(5):494-8. DOI: https://doi.org/10.1093/ajcp/44.5.494
3. Makoni SN, Laber DA. Clinical spectrum of myelophthisis in cancer patients. Am J Haematol 2004;76(1):92-3. DOI: 10.1002/ajh.20046
4. Sook Hee Hong, Myung Woo Lee, Choon Won Kim, Ki Hong Kim. Myelophthisic anemia. Korean J Pathol 1977;11(1):75-83.
5. Clifford GO. The clinical significance of leukoerythroblastic anemia. Med Clin North Am 1966;50(3):779-90. DOI: https://doi.org/10.1016/S0025-7125(16)33177-7
6. Chernow B, Wallner SF. Variables predictive of bone marrow metastases. Cancer 1978;42:2373-78.
7. Rubins JM. The role of myelofibrosis in malignant leukoerythroblastosis. Cancer 1983;51:308-11.
8. Byard RW, Bormains J, Jones TG. Leukoerythroblastosis: A much maligned phenomenon? CMAJ 1987;137(3):191-2.
9. Retief FP. Leuco-erythroblastosis in the adult. Lancet 1964;1:639-42.
10. Aylin CA, Cetin T, Yusuf A, Gulsen K. Leukoerythroblastosis mimicking leukemia: A case report. Iran J Pediatr 2014;24(3):332-3.
11. Naveen K, Divya M, Sheila D, Joseph M, Timothy Rajamanickam. Bone marrow involvement in systemic oxalosis: A rare cause of leukoerythroblastic anemia. Indian J Pathol Microbiol 2011;54(3):659-60. DOI: 10.4103/0377-4929.85145
12. Butler MJ, Yin M, Quddus F. Isolated hemolytic anemia: an unusual manifestation of occult malignancy. Hematol Rep. 2014;6(1):5159. DOI: 10.4081/hr.2014.5159
13. Thiele J, Kvasnicka HM, Zankovich R, Diehl V. Early-stage idiopathic (primary) myelofibrosis- current issues of diagnostic features. Leuk Lymphoma 2002;43(5):1035-41.
14. Humphries JE. Dry tap bone marrow aspiration: clinical significance. Am J Hematol 1990;35(4):247-50.
15. Sitalakshmi S, Anuradha S, Shantala D, Prema D, Betty A. The diagnostic utility of bone marrow trephine biopsies. Indian J Pathol Microbiol 2005;48(2):173-6.
Original Article