Neoplastic Disease

Neoplastic disease can be associated with the following hematologic alterations:

• Hemorrhage

• Nutritional deficiency states

• Dyserythropoietic anemias (including erythroid hypoplasia, sideroblastic anemia, and anemia similar to that seen in chronic inflammation)

• Defect in erythropoietin production

• Hemodilution

• Pancytopenia secondary to marrow invasion or to cytotoxic therapy

• Acquired von Willebrand disease as in Wilms' tumor

• Hypercoagulable states as in non-Hodgkin lymphoma

• Coagulopathy as in acute promyelocytic leukemia

• Leukoerythroblastic anemia and marrow

• Infiltration cytotoxic drug therapy.

Marrow infiltration is suspected when leukoerythroblastic anemia develops. This term signifies the presence of myelocytes and normoblasts with anemia, thrombocy-topenia, and neutropenia. The explanation of this blood picture is that extramedullary erythropoiesis occurs when the marrow is infiltrated, permitting the escape of early myeloid and erythroid cells into the circulation. Normal blood findings, however, do not exclude marrow infiltration.

Bone marrow examination frequently demonstrates infiltration with tumor cells in the presence of pancytopenia. Because metastatic bone marrow involvement from solid tumors may be patchy, a single aspiration is not diagnostic. At least two aspirates and two biopsies should be performed.

The hematologic alterations associated with malignancy should be managed sup-portively and should resolve if the underlying neoplasms can be successfully treated.

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