Leukoerythroblastic Picture vs. Myelophthisis

By William Aird

45 yo M who presented with macrocytic anemia, nRBCs, and a left shift. His peripheral smear demonstrated bands, myelocytes and metamyelocytes, and many tear drop forms (examples of nRBC and tear drops are shown above).

What is this picture called?

The two terms that come to mind are leukoerythroblastic picture and myelophthisis. I frequently make the mistake of treating these terms synonymously. However, they are have different meanings.

Leukoerythroblastic picture describes findings on a peripheral smear (think of “picture” as a smear). It consists of nRBCs and immature WBCs. Tear drops may be present but they don’t have to be. The bone marrow may or not be infiltrated.
Myelophthisis, on the other hand, describes a pathophysiological process in which bone marrow is replaced by fibrosis or metastatic cancer, resulting in extramedullary hematopoiesis. It may or may not be associated with a leukoerythroblastic picture and tear drop cells.