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The patient was extensively worked up for an infectious etiology of her fevers and anemia and, although the studies were negative for viral or bacterial etiologies, her peripheral blood smear showed a leukoerythroblastic picture with occasional circulating myeloid precursors, nucleated red blood cells, and teardrop erythrocytes.
The peripheral blood smear presents with a leukoerythroblastic picture, which includes teardrop RBCs, poikilocytosis, anisocytosis, nucleated red blood cells, and immature myeloid cells.
Idiopathic primary myelofibrosis is a chronic disorder characterized by bone marrow fibrosis, extramedullary hematopoiesis, and a leukoerythroblastic blood profile, and it is usually classified as a myeloproliferative syndrome.
The leukocyte alkaline phosphatase (LAP) score was within normal limits, and daily peripheral blood smears revealed no evidence of leukemic process or leukoerythroblastic reaction.
In the fibrotic stage, extramedullary hematopoiesis takes place primarily in the spleen and the peripheral blood smear shows a leukoerythroblastic morphology with teardrop red cells.
Bone marrow invasion by tumor cells may cause leukoerythroblastic changes or depression of one or more cell lines in the p eripheral blood.
Peripheral blood smear confirmed a leukoerythroblastic picture with evidence of microangiopathic hemolysis (Figure 1).
Then, exclude other causes by demonstrating the absence of an enlarged spleen (>5 cm), underlying systemic disease, and evidence of leukoerythroblastic or dysplastic features on the blood film.
Spider bite hemolytic anemia: positive Coombs' test, erythrophagocytosis, and leukoerythroblastic smear.