Symbols: —, not present; +

common; + +

very common; ±

variable; Î, increased; nl, normal; 4, decreased.

or by tumor necrosis factor production by the malignant clone.57'58 This process may be associated with systemic illness, bone pain, and a leukoerythroblastic blood reaction. The manifestations of bone marrow fibrosis include variable numbers of nucleated red blood cells and an elevation of the white blood count with a left shift in the granulocytic series potentially including the presence of small numbers of myeloblasts. Poly-chromasia, basophilic stippling, anisocytosis, and poikilocytosis are characteristically noted in red blood cells. Tear-shaped ery-throcytes may be the most striking abnormality in the peripheral blood in early cases. Leukoerythroblastosis is characteristic of myelofibrosis and other marrow infiltrative processes such as osteosclerosis, osteopetrosis (marble bone disease), granulomatous accumulation, or metastatic malignancy and can occur in illnesses that result in stimulation of marrow cells, such as infection, anoxia, hemolysis, and bleeding.57

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