Il significato clinico degli eritroblasti: un insolito esordio di anemia refrattaria con eccesso di blasti di tipo 2
Giulia Tombari, Enzo Pazzaglia
Patologia Clinica, AO Ospedali Riuniti Marche Nord, Pesaro (PU)
The clinical relevance of nucleated red blood cells: an unusual onset of refractory anaemia with excess blasts
Nucleated red blood cells (NRBCs) in adult peripheral blood (PB) are often a signal of severe haemopoietic stress. Refractory anaemia with excess blasts (RAEB) is a myelodysplastic syndrome characterized by ineffective hemopoiesis and diserytropoiesis; two categories of RAEB (1-2) are recognized, defined by the amount of blasts in the bone marrow (BM) and in PB. We describe an unusual onset of RAEB-2 in a patient with asthenia, weigh loss and fatigue. The automated blood cells analysis and optical microscopic PB smear revision showed severe anemia, mild trombocytopenia, blasts, NRBCs and dysplasia. After definitive diagnosis (RAEB-2) and one year of appropriate treatment, the patient shows normalized haematological values with just some optical microscopic hints of dysplasia. NRBCs play a pivotal role to trigger the diagnostic process and are useful in the follow-up. We highlight the role of automated haematology analysers with improved features in NRBCs analysis.