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Table 101.5

Pancytopenia: Clues from the Peripheral Blood Film

DiagnosisTypical blood film findings
Acute leukaemia

Pancytopenia, with or without a population of blast cells

Specific morphological features may help differentiate between myeloid and lymphoblastic leukaemia, and may raise the suspicion of acute promyeloblastic leukaemia

LymphomaVariable; possible circulating lymphoma cells (e.g. CLL, mantle cell lymphoma, hairy cell leukaemia); possible leucoerythroblastic change (nucleated red blood cells, myelocytes)
MyelofibrosisCytopenias with prominent red cell changes, including teardrop poikilocytes, nucleated red cells
MyelodysplasiaVariable red cell size and shape; hypogranular and abnormally segmented neutrophils
Metastatic malignancyLeucoerythroblastic film (nucleated red blood cells, myelocytes)
B12 or folate deficiencyOval macrocytes, hypersegmented neutrophils
Liver diseaseMacrocytosis, target-form red cells
Acute viral infection (EBV, CMV)Atypical lymphocytes; polychromasia/spherocytes if haemolysis