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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