Systematic review about etiologic association to the leukoerythroblastic reaction
Ebellins Tabares Calvache1, Allison Dessiret Tabares Calvache2, Gustavo Adolpho Moreira Faulhaber1
1Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Background And Purpose:
Leukoerythroblastic reaction (LER) is characterized by the presence of immature erythroid cells and myeloid precursors (metamyelocytes, myelocytes, promyelocytes, myeloblasts, and blasts) as well as, exclusively in myelofibrotic disorders, teardrop cells in the peripheral blood (J Pathol Bacteriol, 42, 1936, 541; Semaine Med, 22, 1902, 373). Research on how to interpret LER and its meaning in clinical practice is scarce, and there is no consensus on the diagnostic criteria. We summarize the current evidence with the aim of clarifying the knowledge on this subject.
Methods:
We conducted a comprehensive search of the PubMed-MEDLINE, EMBASE and ELSEVIER databases, the Cochrane Library, Google Scholar, and medical journals to identify relevant papers.
Results:
Our search identified 425 papers, of which, 35 (11 trials and 24 case reports) ultimately met the inclusion criteria. These showed two principal groups of diseases associated with leukoerythroblastosis (LEB), corresponding to solid and hematological malignancies. The other etiologies, in order of frequency, were hemolytic diseases, infection, and others, while hemorrhage was only reported in the trials group.
Conclusion:
The literature on LER is scarce and heterogeneous. The etiological factors of LER are diverse, and its presence in malignant disease is an indicator of disease progression and an adverse prognosis suggesting poor survival. In those cases where LER had neither hematological nor solid neoplasms, its manifestation, prognosis and its impact on our daily clinical practice are unknown.
Insights
Leukoerythroblastic reaction (LER) is a blood finding with diverse causes, often indicating malignancy progression and poor prognosis. Its significance in non-cancerous conditions requires further clinical investigation.
Area of Science:
- Hematology
- Pathology
- Oncology
Background:
- Leukoerythroblastic reaction (LER) involves immature red and white blood cells in peripheral blood.
- LER is also associated with teardrop cells in myelofibrotic disorders.
- Current understanding and diagnostic criteria for LER are limited.
Purpose of the Study:
- To clarify the knowledge and clinical significance of leukoerythroblastic reaction.
- To summarize current evidence on LER interpretation and its impact on clinical practice.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed-MEDLINE, EMBASE, ELSEVIER, Cochrane Library) and medical journals.
- 35 relevant papers, including trials and case reports, were selected for analysis.
Main Results:
- Leukoerythroblastosis (LEB) is primarily associated with solid and hematological malignancies.
- Other causes include hemolytic diseases, infections, and hemorrhage.
- The frequency of these etiologies was analyzed based on the reviewed literature.
Conclusions:
- The literature on LER is scarce and heterogeneous, with diverse etiological factors.
- LER in malignant disease indicates progression and predicts a poor prognosis.
- The clinical implications, prognosis, and daily practice impact of LER in non-neoplastic, non-hematological conditions remain unknown.
Related Concept Videos
01:27Disorders of Leukocytes
Leukopenia may result from bone marrow disorders, autoimmune diseases, and infectious diseases. For example, conditions such as multiple myeloma and aplastic anemia can impair the bone marrow's ability to produce adequate leukocytes. Similarly, autoimmune diseases like lupus and viral infections such as HIV can prompt the immune...
01:19Rh Blood Group
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...