Pure erythroid leukaemia is a malignant proliferation of immature cells of the erythroid lineage. It is rare, accounting for less than 5% of AML

Diagnostic Criteria (WHO 2016)

  • Blast < 20% in the peripheral blood or bone marrow
  • Erythroid cells >80% of the bone marrow cells, with ≥ 30% being pro-erythroblasts
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Blood Film Features:

  • Myeloblast
  • Erythroblast: round nuclei, open chromatin, with nucleoli, cytoplasm very basophilia with occasional vacuoles
  • Dysplastic nucleated red blood cell
  • Oval macrocytes
  • Basophilic stippling
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Bone Marrow Features:

  • Presence of pro-erythroblasts: large cells with deeply basophilic cytoplasm, round nuclei with open chromatin and prominent nucleoli.
  • Immature erythroid cells: round nuclei and basophilic cytoplasm. Some may be vacuolated.
  • Markedly decrease granulocyte component with myeloblasts <20%.
  • Cytochemistry: myeloperoxidase – negative, Sudan black B – negative, periodic acid–Schiff – block positivity in erythroblasts

Other features to look for:

  • Dysmegakaryopoiesis
  • Ring sideroblasts

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