A leucoerythroblastic picture is used to describe the presence of immature myeloid and nucleated red cells in the peripheral blood often as a consequence of disturbance of the bone marrow architecture by abnormal tissue. Causes are secondary carcinoma, myelofibrosis, thalassemia, active hemolysis, multiple myeloma, lymphoma, Gauchers, Niemann Pick, Marble Bone Disease. (DeGruchy). I am still suspicious of Disseminated Histiocytosis but still lingering is the fact that the cells described in the bone marrow have not been identified as Histiocytes. Acute Monocytic Leukemias and Storage disorders could also present like this. What percentage of the bone marrow cells are the ones described? Are they Histiocytes? Do they have Birbeck granules? Do we have a Paul Bunnel available? Is there hemophagocytosis?
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